CUSTOMER NAME

    CUSTOMER ADDRESS

    LIABILITIES

    MTHLY PMT

    OUTSTANDING

    ASSETS

    MTHLY PMT

    VALUE

    BANK OVERDRAFT

    Cash at Bank

    CREDIT CARDS

    MORTGAGES

    PROPERTY

    FINANCE COMMITMENTS

    MOTOR VEHICLES

    OTHER COMMITMENTS

    PLANT & EQUIPMENT

    CREDITORS

    DEBTORS

    OTHER

    OTHER

    FURNITURE & HOUSEHOLD GOODS

    SUPERANNUATION

    TOTAL LIABILITIES

    SURPLUS

    TOTAL

    TOTAL

    I/We acknowledge that the above information is true and correct. I/We are not undisclosed bankrupt and there are no unsatisfied judgements against me/us.

    I Agree