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Title:   First Name:
Last Name:   Contact Number:
Mobile Phone:   Email:
State:   Loan Term (Years):
Number of Dependants:   Is this a Joint Application:
  Yes     No
Applicant 1    
Gross salary or wages:   Gross rental income:
Other net income: (eg social security payments, net allowances)
Monthly expenses
General living expenses (eg food, entertainment, petrol)
Ongoing repayments to other loans (eg personal loan)
Other commitments (eg insurance other than house, additional superannuation contributions)
Additional details
Combined limit of credit cards, store cards and overdrafts
Additional Comments
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