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To ensure your Credit Representative makes the correct financial product recommendations they must have reasonable grounds for making those recommendations. This means that a Credit Representative must make reasonable inquiries about the consumer’s financial situation, consumer’s requirements and objectives, take reasonable steps to verify the consumer’s financial situation and take reasonable steps prescribed by the regulation to verify all matters relating to this application to ensure the credit contract is not unsuitable for the consumer. We accept no liability for any recommendation given on the basis of inaccurate or incomplete information.


What you have just read      Yes No



Your Email Address:



Confirm Email Address:


1. PERSONAL DETAILS
Applicant 1
First
Name:		 Second
Name:
Surname: Gender:
Date of
Birth:		 Marital
Status:
Dependents: Ages:
Driver’s
Licence:		 Expiry:
Applicant 1
Street
Address:
Postcode: State:
Postal
Address:
Postcode: State:
Duration at Residence : Years :
Home
Phone No:
Mobile
Phone No:
Bus
Phone No :
Applicant 2
First
Name:		 Second
Name:
Surname: Gender:
Date of
Birth:		 Marital
Status:
Dependents: Ages:
Driver’s
Licence:		 Expiry:
Applicant 2
Street Address :
Postcode : State:
Postal Address :
Postcode : State:
Months :
Mobile Phone No:
Bus Phone No :

    PREVIOUS ADDRESS (IF LESS THAN 3 YEARS IN CURRENT)
Street
Address :
Postcode: State:
Duration at Residence : Years :
Residential Status :
$ per
own   mortgage   rent   board  
employer subsidized
Landlord
Name :
Street Address :
Postcode : State:
Month :
Residential Status :
$ per
own   mortgage   rent   board  
employer subsidized
Duration of Residence: Years
Phone:


Page 2

2. Employment Details
Applicant 1
Full Time   Part Time   Casual   Contract  
Self Employed   Not Employed
Occupation :
Name of Employer :
Street Address :
Postcode :
State :  
Phone No :
Contact Name :
Position/Relationship:
Duration of Employment :

  Years       Months  
Applicant 2
Full Time   Part Time   Casual   Contract  
Self Employed   Not Employed
Occupation :
Name of Employer :
Street Address :
Postcode :
State :
Phone No :
Contact Name :
Position/Relationship:
Duration of Employment:

  Years       Months  
PREVIOUS EMPLOYMENT (IF LESS THAN 3 YEARS IN CURRENT)
Occupation :
Name of Employer :
Duration of Employment :

 Years      Months  
Bank / Branch:
References:Finance
References:Personal
Accountant:
Occupation :
Name of Employer :
Duration of Employment :

  Years       Months  
Bank / Branch:
References:Business
Nearest Living Relative:


Page 3

3. PURPOSE OF PROPOSAL
Why are you seeking credit :

4. NEW ASSET DETAILS and LOAN STRUCTURE
Supplier :
Phone No :
Salesperson :
Description of Equipment: Year / Make/ Model :
New Used

Auto Man
Extras :
Trade :
Purchase Price : $ Loan Term :
Less Cash Deposit : $ Balloon : $
Less Trade : $
Plus Payout on Trade Bank : $
Amount Financed : $


Page 4

ASSETS AND LOANS
$  
$  
$  
$  
$  
$  
$  


STATEMENT OF POSITION
PROPERTY
AddressValueBankPaymentsBalance$

CAR,BOATS,CARAVANS,MOTOR BIKES,OTHER ASSETS:
Asset Value Bank Started(m/y) Original Amount
borrowed		 Term Payment Ballon
CREDITS CARD LIMITS MONTHLY PAYMENT BANK BALANCE


Others :
Others :


Page 5

5. INCOME VS EXPENDITURE CAPACITY
# To work out monthly figures from fortnightly, simply multiply by 26 then divide by 12.
## To work out monthly figures from weekly, simply multiply by 52 then divide by 12.
MONTHLY INCOME
Applicant 1(Net):
Net Income: $
Pension: $
Child Care $
Child Support: $
Rental: $
Other: $
Applicant 2(Net):
Net Income: $
Pension: $
Child Care $
Child Support: $
Rental: $
Other: $
 
TOTAL INCOME : $
SURPLUS/DEFECIT : $
MONTHLY EXPENDITURE
Rent/Board: $
Food $
Insurances: $
Fuel: $
Entertainment: $
Electricity: $
Gas: $
Phone: $
Internet: $
Other: $
LOANS
Mortgage: $
Rental Property Loan: $
Credit Cards: $
Car Loan1: $
Car Loan2: $
Other Loans: $
This Loan: $
 
TOTAL EXPENSES : $



Page 6

ESTABLISHING CLIENTS’ OBJECTIVES AND BORROWING NEEDS

I/We are not undischarged bankrupt and there are no unsatisfied judgements against me/us. Yes No
I/We declare that the name provided above is my/our current true legal name. Yes No
I/We declare that the information given in this application is true and correct. Yes No
I/We authorise you to contact any person/company to obtain necessary data. Yes No
I/We confirm that the income and expenditure detailed above are true and correct, and acknowledge
I/we have the financial capacity to meet the commitments being entered into under this transaction. Yes No
What are your expectations for an ideal Credit Representative relationship?

  
Is there anything in your credit history that would stop you getting a loan? Yes No

 
Are you experiencing financial stress or hardship? Yes No
If yes, please explain:
  
From which lenders have you borrowed money before? How satisfied were you with those products and the lenders?
  
Additional payments
Why is it important to you to make additional payments on your loan?
Rate
Could you tell me what is important about rate to you?
Pay off quickly
Why is it important to you to pay off your loan quickly?
How did you come across us ?
   Camper Trailer Touring Mag.

   Caravan & Motor Home Mag.

   Caravan & Motor Home DVD.

   Overlander Mag.

   Truckin Life Mag.

   4WD Action Mag.

   4WD Action DVD.

   Caravancampingsales.com website.

   All 4 Adventure.

   Camper Trailer Australia Mag.

   Google

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    By ticking this box, you acknowledge that you are submitting private information, subject to the Commonwealth Privacy Act, to Fortified Finance & Leasing Pty Ltd. Your information will not be passed on to any lender without your written consent. Financial Services Credit Guide, Client Acknowledgement and Privacy Consent Forms will be emailed to you automatically (to the email address above) once you submit this online application.


Australian Credit License Number 392149.

Fortified Finance and Leasing are Australia Credit License holders and as such, are qualified to provide you with unbiased, independent advice on seeking loans. You should only be dealing with qualified professionals.