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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
$
p/w
Contact
(please include area codes)
Home Phone
Mobile Phone
Bus Phone
Email
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
$
p/w
Contact
(please include area codes)
Home Phone
Mobile Phone
Bus Phone
Email
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
Select
Variable
Fixed
2. Mortgage for Property 2
Select
Variable
Fixed
3. Mortgage for Property 3
Select
Variable
Fixed
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
No
8a. 2nd Credit Card
n/a
8b. 2nd Credit Card - Credit Limit
Do you pay your Credit Card off in full every month?
Yes
No
9a. 3rd Credit Card
n/a
9b. 3rd Credit Card - Credit Limit
Do you pay your Credit Card off in full every month?
Yes
No
10a. Other Credit Card
n/a
10b. Other Credit Card - Credit Limit
Do you pay your Credit Card off in full every month?
Yes
No
11. Bank Overdraft
n/a
12.Other Debt
n/a
Total
Nett take home pay per
Select
Week
Fortnight
Month
$
Living expenses per month excluding the above expenses:
$
How did you find out about us?
Existing Client
Television
Radio
Newspaper
Direct Mail
Seminar
Recommendation
Search engine
Internet
Other
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.
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