Applicant 1

Surname*

First Name*

Middle Name*

Are you renting
YesNo

Agent Details

Rental Amount

Current Address

State

Postcode

Date moved in

Previous Address (if less than 3 years at above address)

State

Postcode

How long at above Address

Postal Address

State

Postcode

Date of Birth:

Driver’s Licence No

Expiry Date

Date of Issue

State

Medicare Card No

Expiry Date

Mobile No*

Home Phone No*

Email*

No. of Dependants

Ages

Name

DOB

Name

DOB

Name

DOB

Name

DOB

Smoker

General Health

Home & Contents Insurance Details

Insurer

Policy No

Expiry Date

Current Employment

Occupation

Name of Employer

Employer Address

Phone No

Start Date

Previous Employment

Occupation

Name of Employer

Employer Address

Phone No*

Start Date

NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU

Relationship

Phone*

Account Details

BSB

Account Number

Financial Institution

Branch

Have you ever been bankrupt or have adverse credit history?

YesNo

Details of adverse credit history

Circumstances
PaidUnpaid

Date

Amount

Applicant 2

Surname*

First Name*

Middle Name*

Are you renting
YesNo

Agent Details

Rental Amount

Current Address

State

Postcode

Date moved in

Previous Address (if less than 3 years at above address)

State

Postcode

How long at above Address

Postal Address

State

Postcode

Date of Birth:

Driver’s Licence No

Expiry Date

Date of Issue

State

Medicare Card No

Expiry Date

Mobile No*

Home Phone No*

Email*

No. of Dependants

Ages

Name

DOB

Name

DOB

Name

DOB

Name

DOB

Smoker

General Health

Home & Contents Insurance Details

Insurer

Policy No

Expiry Date

Current Employment

Occupation

Name of Employer

Employer Address

Phone No

Start Date

Previous Employment

Occupation

Name of Employer

Employer Address

Phone No*

Start Date

NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU

Relationship

Phone*

Account Details

BSB

Account Number

Financial Institution

Branch

Have you ever been bankrupt or have adverse credit history?

YesNo

Details of adverse credit history

Circumstances
PaidUnpaid

Date

Amount

Consumer Client Data Collection

Applicant 1

Previous Address (if less than 3 years at above address)

Postal Address

Home & Contents Insurance Details

Current Employment

Previous Employment

Account Details

Details of adverse credit history

Applicant 2

Previous Address (if less than 3 years at above address)

Postal Address

Home & Contents Insurance Details

Current Employment

Previous Employment

Account Details

Details of adverse credit history