What is your relationship status?* Single Couple Full Name #1* First Name Last Name Gender* Male Female DOB* DD slash MM slash YYYY Address* Street Address Suburb State Postcode Email* Contact Phone Number*Employment Status* Full time Part time Casual Self Employed What is your gross annual salary (before tax)? Do you receive Centrelink Family Tax Benefits? Yes No If so how much and what is it for?* _How long have you been employed at your current job? Do you have any bad credit ratings? Yes No Full Name #2* First Name Last Name Gender* Male Female DOB* DD slash MM slash YYYY Address* Street Address Suburb State Postcode Email* Contact Phone Number*Employment Status* Full time Part time Casual Self Employed What is your gross annual salary (before tax)? Do you receive Centrelink Family Tax Benefits? Yes No If so how much and what is it for?* _How long have you been employed at your current job? Do you have any bad credit ratings? Yes No Do you own a house? Yes No Is it mortgaged? Yes No If yes what is the loan balance? What is the monthly repayments? What is the value of your house? What is your total personal loan borrowings excluding credit cards?(Personal loans and credit cards are assessed differently) What is your estimated monthly minimum loan repayment? What is your total credit limit? What is your total current savings? Are you renting? Yes No What is your rental cost per week? Who do you rent through? Are you a first home buyer? Yes No Do you have a family member that will guarantee your loan? Yes No Do you have children? Yes No How many? How old are they? What is your residency status #1: Australian citizen Permanent resident Visa What is your residency status #2: Australian citizen Permanent resident Visa I authorize the Broker to share the financial information with Habitat NT Pty Ltd staff Yes No By submitting this form, you authorise the exchange of your information that may be considered Private, between Habitat and its chosen financial lenders and agents.* I agree
