Debt Consolidation Loan Application

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Congratulations, you are one step away from completing your personal loan application. Debt Consolidation Loan Application

Sit back, relax and complete your debt consolidation loan online application which should take approximateley 2 to 3 minutes. For your security we use AES 256 bit encryption, so the information contained in your application is secure.

Please complete all the questions to assist us in processing your application as quickly as possible. If you are unsure of anything while completing the application please phone us on 0800151221.

Thank you, We will be in contact with you as soon as possible.

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Where did you hear about us?

Please select one of the following options:

Newspaper (Please Specify)	Internet Yellowpages
TV One	Internet Whitepages
TV Two	The Yellow Pages Phonebook
Prime TV	Auto Trader
Sky TV	Referal (Please tell us who refered you)
Car dealer magazine	Search Engine (Please tell us which one)

If you heard about us from somewhere other than the above choices, can you please describe it here:

FINANCE DETAILS

Please tell us the amount you will require.
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Settlement amount: (this is the amount required to clear your current finance)
Name of the company this is payable to:
Total amount you require to consolidate your debts:

SECURITY DETAILS

Please tell us what you will be using for security.
Security Type:		Details
		Identifier:
Security Type:		Details
		Identifier:
Security Type:		Details
		Identifier:
Security Type:		Details
		Identifier:
Security Type:		Details
		Identifier:

OTHER SECURITY DETAILS

PERSONAL DETAILS

Who is applying for finance?
Type of applicant:
Individual applicant details.
Applicant 1		Applicant 2
Title:		Title:
Surname:		Surname:
First name:		First name:
Middle name:		Middle name:
Date of birth:	19	Date of birth:	19
No. of dependents:		No. of dependents:
Marital status:		Marital status:
Current address:		Current address:
Suburb:		Suburb:
City:		City:
Residential status:		Residential status:
How long have you lived here:		How long have you lived here:
Previous address: (if less than 3 years at current)		Previous address: (if less than 3 years at current)
Suburb:		Suburb:
City:		City:
How long were you there for:		How long were you there for:
Home phone:		Home phone:
Work phone:		Work phone:
Mobile:		Mobile:
Email address:		Email address:
Current occupation:		Current occupation:
Employer:		Employer:
Address:		Address:
City:		City:
How long have you worked here:		How long have you worked here:
Previous occupation:		Previous occupation:
Previous employer: (if less than 3 years at current)		Previous employer: (if less than 3 years at current)
How long did you work there:		How long did you work there:

CREDIT REFERENCE

Please tell us the name of the company you have had or currently have finance with.

Credit reference is:

Type of account:

Company:

Branch:

Please tell us which bank you use.

Bank:

Branch:

Accounts held:
(select all that apply)

Cheque

Savings

Credit card

Other

If other, please specify:

NET MONTHLY INCOME

If you are self employed please provide your accountant details.
Accountant:		Phone:		Fax:


Applicant 1 (What you receive after tax)		Applicant 2 (What you receive after tax)
Income from employment:		Income from employment:
Other income:		Other income:
Monthly total:		Monthly total:
Please tell us where you receive your "other" income from:


Please list your current assets and liabilities.
Assets		Liabilities	Balance	Monthly payments	Limit
Savings / Invest:	$	Bank overdraft:	$	$	$
Home & section:	$	Mortgages/rent/board:	$	$	$
Rental property:	$	Personal loan:	$	$
Cars n^o:	$	Hire purchase:	$	$
Home Contents:	$	Hire purchase:	$	$
Other:	$	Credit card:	$	$	$
Business equity:	$	Credit card:	$	$	$
Total:	$	Total:	$	$

LEGAL

Additional comments:

Please tick the following boxes to include any of our Premier Protection Products with your loan:

	Vehicle Warranty	(more information)
	Payment Protection	(more information)
	Vehicle Insurance	(more information)
	Motorcycle Insurance	(more information)

Applicant 1
Drivers licence n^o (5a):
Card version n^o (5b):
Please read the Terms and Conditions. Please read the Privacy Statement. I have read and accept the Terms and Conditions and I agree with the Privacy Statement within this website:

Applicant 2
Drivers licence n^o (5a):
Card version n^o (5b):
Please read the Terms and Conditions. Please read the Privacy Statement. I have read and accept the Terms and Conditions and I agree with the Privacy Statement within this website:

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