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Surname*
First Name*
Middle Name*
Are you renting YesNo
Agent Details
Rental Amount
Current Address
State
Postcode
Date moved in
How long at above Address
Date of Birth:
Driver’s Licence No
Expiry Date
Date of Issue
Medicare Card No
Mobile No*
Home Phone No*
Email*
No. of Dependants
Ages
Name
DOB
Smoker
General Health
Insurer
Policy No
Occupation
Name of Employer
Employer Address
Phone No
Start Date
Phone No*
NAME & ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
Relationship
Phone*
BSB
Account Number
Financial Institution
Branch
Have you ever been bankrupt or have adverse credit history?
YesNo
Circumstances PaidUnpaid
Date
Amount
INCOME - SALARY/WAGES
WEEKLY AMOUNT
MONTHLY AMOUNT
COMMENTS / NOTES
INCOME SUB TOTAL
OTHER INCOME
Rent from Investment Property
Child Allowance / Government Allowance
Child Support
Interest from Investments eg. Term Deposit
Overtime
Share Dividends
Other Income:
OTHER INCOME SUB TOTAL
TOTAL INCOME
EXPENSES - HOUSEHOLD
Body Corporate
Cable TV
Child Support Expense
Electricity
Gas
Home Insurance
Internet
Mortgage Repayments
Phone and/or Mobile
Rates
Rent
Water
EXPENSES - HOUSEHOLD SUB TOTAL
EXPENSES - LIVING COSTS
Cigarettes
Clothing
Groceries
Medical Bills - Doctors/Specialist
Personal Care - Hairdresser, Facials etc
Pet Food
Private Health Cover
EXPENSES - LIVING COSTS SUB TOTAL
EXPENSES - ENTERTAINMENT
Alcohol
Camping / Weekend Getaways
Eating Out - Restaurants, Cafes etc
Gym / Personal Trainer
Holidays - Flights, Accommodation etc
Presents - All occasions
Subscriptions - Sport Club, Sport Team
EXPENSES - ENTERTAINMENT SUB TOTAL
EXPENSES - OTHER FINANCIAL COMMITMENTS
Credit Card/s
Income Protection - Client 1:
Income Protection - Client 2:
Investment Property Loan
Personal Loan
Risk Insurance - Client 1:
Risk Insurance - Client 2:
Other:
EXPENSES - OTHER FINANCIAL SUB TOTAL
EXPENSES - TRANSPORT
Car Insurance
Petrol
Services
Registration
Maintenance
Public Transport - Bus, Train, Taxi
EXPENSES - TRANSPORT SUB TOTAL
Total Expense
TOTAL INCOME - Minus
TOTAL EXPENSES
TOTAL LEFT OVER / SURPLUS
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