Prime Alliance - Application

PERSONAL DETAILS (To be completed for all parties)
Applicant 1	Applicant 2

Last Name

First Name

Date of Birth

Marital Status

Number of
Dependants

Address

Suburb

State

Postcode

Status

Owned

Buying

Renting

Boarding

p/w

Contact

(please include area codes)

Home Phone

Mobile Phone

Bus Phone

Employment Status

Self Employed

Full Time

Part Time

Casual

Annual Gross
Income Less Super

Occupation

Years in current
employment

Other Income per
annum. eg. Rent

First Name

Last Name

Date of Birth

Marital Status

Number of
Dependants

Address

Suburb

State

Postcode

Status

Owned

Buying

Renting

Boarding

p/w

Contact

(please include area codes)

Home Phone

Mobile Phone

Bus Phone

Employment Status

Self Employed

Full Time

Part Time

Casual

Annual Gross
Income Less Super

Occupation

Years in current
employment

Other Income per
annum. eg. Rent

STATEMENT OF ASSETS & LIABILITIES

IMPORTANT INFORMATION – please read carefully:

For Prime Alliance to complete your Confidential Financial Analysis precisely, you must provide the correct figures.
When entering values of $1000 or over please be careful to enter the correct values:

Incorrect figures will result in an incorrect Confidential Financial Analysis which you'll be unable to benefit from.

ASSETS

Location

(where applicable)

Value $

1. Home/Property

2. Property

3. Property

4. Car/s

5. Household Effects

6. Shares

7. Managed Funds

8. Other Investments

9. Savings

10. Superannuation

11. Other Assets

Total $

LIABILITIES

Provider(s)

Int Rate

Variable / Fixed

Monthly Payment

$ Owing

1. Mortgage for Property 1

2. Mortgage for Property 2

3. Mortgage for Property 3

4. Lease / Loan

n/a

5. Personal Loan

n/a

6. Other Loan

n/a

7a. 1st Credit Card

n/a

7b. 1st Credit Card - Credit Limit

Do you pay your Credit Card off in full every month?

Yes

8a. 2nd Credit Card

n/a

8b. 2nd Credit Card - Credit Limit

Do you pay your Credit Card off in full every month?

Yes

9a. 3rd Credit Card

n/a

9b. 3rd Credit Card - Credit Limit

Do you pay your Credit Card off in full every month?

Yes

10a. Other Credit Card

n/a

10b. Other Credit Card - Credit Limit

Do you pay your Credit Card off in full every month?

Yes

11. Bank Overdraft

n/a

12.Other Debt

n/a

Total

Nett take home pay per

Living expenses per month excluding the above expenses:

How did you find out about us?

Have you communicated with anyone in our office? If so, please tell us who:

I agree to the terms and conditions below. The information I am about to supply is true and precise to my financial situation.

Before you submit your information we advise you to Print a Copy for your records.

Prime Alliance is committed to ensuring the confidentiality and privacy of our Customers' personal information. In relation to managing personal information, Prime Alliance abides by the National Privacy Principles contained in the Privacy Act. For the purpose of assisting you with an analysis we collect and record your personal information. We may distribute your personal information within our company and/or disclose it to other parties in connection with our normal business operations. However, we do not disclose any personal information for any other purposes without your consent. If we do, it will only be disclosed to someone else as required by law. If you do not provide us with your personal details, we may not be able to provide our services to you.