Combined Client Profile Preliminary Assessment

Given name(s) *

Surname *

Current Address *

State *

Post Code *

Years*

Months

Previous Address (if less than 3 years)

State

Post Code

Status * Buying Renting Boarding Own

Home Telephone Number

Work Telephone Number

Mobile Number

Email Address *

Date of Birth *

Gender
Male Female

Drivers Licence Number

Expiry

Marital Status

Number of Dependents and Age

Current Occupation

Employer

Employer Address

State

Post Code

Telephone Number

Years

Months

Previous Occupation (if less than 3 years)

Previous Employer (if less than 3 years)

Years

Months

Friend's Name

Contact Details

Relative's Name

Contact Details

Section 4 – Monthly Income

if any question is not applicable, please leave the field blank

Salary/Wages $

Overtime $

Commission $

Self-Employment $

Family Allowance $

Maintenance $

Other $

Total Income $ *

Section 5 – Monthly Expenses

if any question is not applicable, please leave the field blank

Mortgage/Home $

Rent/Board $

Mortgage(Investment Property) $

Credit Card Payments $

Other Loan Repayments $

Lenders Name $

Loan Start Date $

Years

Months

Maintenance/Child Support $

General Living $

School fees & Assoc. costs $

Insurances (Health/Life) $

Telephone/Internet $

Lifestyle $

Foreseeable Expenses $

Other Ongoing Commitments $

Total expenses $

Cash in Bank and Branch $

Term Deposits $

Residence Property Value $

Investment Property Value $

Motor Vehicle $

Household Effects $

Shares/Other Investments $

Other Assets $

Description of Other Assets $

Total Assets $ *

Mortgage/Principal Residence $

Mortgage - Investment $

Total Owing on Credit card(s) $

Credit Card Limit(s) $

Amount of Overdraft $

Other Loans $

Other Liabilities $

Total Liabilities $ *

Any previous credit impairment/default or previous bankruptcy?
Yes No
Please Specify:

Are any of the applicant's in arrears with respect to existing debt?
Yes No
Please Specify:

Do you have the ability to meet current and future financial obligations?
Yes No
Please Specify:

Do you anticipate any change to your income over the next 12 months?
Yes No
Please Specify:

Do you anticipate any change to your expenses over the next 12 months?
Yes No
Please Specify:

House

Car

Bike

Truck

Marine

Caravan

Equipment

Aircraft

Business

Insurance

Personal

Combined Client Profile Preliminary Assessment

Section 1 – Personal Details

Section 2 – Employment details

Section 3 – Contacts

Section 4 – Monthly Income

Section 5 – Monthly Expenses

Section 6 – Assets

Section 7 – Liabilities

Section 8 – Further Questions