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1. Personal Details

Title
First Name
Surname
Address
Suburb
State
Postcode
Email
Phone (BH)
Phone (AH)
Mobile
No. of borrowers
No. of dependants

2. Employment Status

Employment status
Duration of employment		Years Months
Total annual income of all borrowers ($)

If self-employed
Do you have an ABN?		Yes No
If yes, for how long have you had an ABN?		Years Months
How long have you been self employed?		Years Months

3. Refinancing (If you are a First Home Buyer a minimum 15% deposit is required)

Amount you owe on your mortgage ($)
Property Value($)
Are you behind in your mortgage repayments?		Yes No
How many months are you behind?
Do you have any other debts to consolidate?		Yes No
Total loan amount of debts you want to consolidate ($)
Other Comments