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Broker Appointment Client Information Form (Appt)
Application Type

Applicant 1 Details

Applicant 1 Details

Dependents

Please list ages of all dependents

Applicant 1 current address

Current address
Current address
Line 1
Line 2
City
State
Post Code
Current residential status
$

Applicant 1 contact details

Previous address

3 years residential history required
Previous address
Previous address
Line 1
Line 2
City
State
Post Code
Previous residential status

Applicant 1 resident details

Are you a tax resident of a country other than Australia?

Applicant 2 Details

Applicant 2 Details

Dependents

Please list ages of all dependents, if different from Applicant 1

Applicant 2 current address

Current address
Current address
Line 1
Line 2
City
State
Post Code
Current residential status
$

Applicant 2 contact details

Applicant 2 previous address

3 years residential history required
Previous address
Previous address
Line 1
Line 2
City
State
Post Code
Previous residential status

Applicant 2 resident details

Are you a tax resident of a country other than Australia?

Applicant 1 employment details

Applicant 1 Employment Details

Address
Address
Line 1
Line 2
City
State
Post Code
Employment type
$
Gross income (before tax)
If less than 3 years at current job
Address
Address
Line 1
Line 2
City
State
Post Code
Employment type

Applicant 2 employment details

Applicant 2 Employment Details

Address
Address
Line 1
Line 2
City
State
Post Code
Employment type
$
Gross income (before tax)
If less than 3 years at current job
Address
Address
Line 1
Line 2
City
State
Post Code
Employment type

Other income

(e.g. pensions, dividends, family allowance)
$
Gross income (before tax)
Owner
Add other income + Remove

Assets

Property assets

Address
Address
Line 1
Line 2
City
State
Post code
Country
Property type
$/ week
Owner
$
Add property + Remove

Cheque, savings, term deposit & other accounts

Owner
$
Add account + Remove

Investments, including superannuation, shares, managed funds etc.

Owner
$

Owner
$
Add investment + Remove

Other assets including home contents insured value, boats, tools of trade, business goodwill etc.

Owner
$

Owner
$
Add asset + Remove

Motor vehicles

Owner
$
Add vehicle + Remove

Liabilities

Housing loans, overdrafts, business/company debts, or guarantees secured by mortgages.

$
Add loan + Remove

Credit cards, store cards, unsecured overdrafts, etc.

$
$
Add another + Remove

Other loans and liabilities including personal loans, HECS/HELP, leases, child support, zip/afterpay, etc.

$
Borrower
$
Add another + Remove

Monthly living expenses

$
$
$
$
$
$
$
$
$
$
$
$

Additional monthly living expenses

$
Add another + Remove
$

Additional comments

Include additional address/employment history if required
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