Loan Application Form

Engagement Brochure – your confidentiality is our concern.

Personal Information
Borrower One Name
Prefix First Last
Borrower Two Name
Prefix First Last
Borrower One Date of Birth
Borrower Two Date of Birth
Home Phone
Mobile Phone
Email
Enter Email Confirm Email
Residential Address
Street Address City State / Province / Region ZIP / Postal Code Country
Is your POSTAL ADDRESS the same as the above?
- Yes
- No
Postal Address
Street Address City State / Province / Region ZIP / Postal Code Country
Number of Dependents

Income Information
Gross Income
You can enter up to FOUR gross incomes, simply press the (+) for another row.
Gross $$ Initials of Person
Rental Income
Gross $$ Initials of Person
Family Allowance
Gross $$ Initials of Person
Investments
Gross $$ Initials of Person
Other Income
You can enter up to FOUR gross incomes, simply press the (+) for another row.
What is it? Gross $$ Initials of Person
Property Management Statements
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 30 MB.
Family Allowance Statements
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 30 MB.
Tax Return Statements showing investments
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 30 MB.

Assets
Please list each individual asset and loan, please do not combine.
What Assets Do you Have?
Please check all that apply.
- Home Market Value
- Investment Properties
- Shares
- Investment Fund
- Cash
- Car Value
- Other Assets
Home Market Value
Initials of Owner Amount ($)
Investment Properties
You can enter up to FIVE properties, simply press the (+) for another row.
Initials of Owner Amount ($)
Shares
Initials of Owner Amount ($)
Investment Fund
Initials of Owner Amount ($)
Cash
Initials of Owner Amount ($)
Car Value
You can enter up to TWO Cars, simply press the (+) for another row.
Initials of Owner Amount ($)
Other Assets
You can enter up to FIVE Other Assets, simply press the (+) for another row.
What is it? Initials of Owner Amount ($)
Amount of Personal Effects ($)
Superannuation Fund
You can enter up to TWO Superannuation Funds, simply press the (+) for another row.
Initials of Owner Amount ($)

Liabilities
Please list each individual asset and loan, please do not combine.
What Liabilities do you have?
- Home Loan
- Investment Property Loan
- Shares Loan
- Investment Fund Loan
- Car Loan
- Credit Card
- Store Card
- Other Loans or Liabilities
Please check all that apply.
Home Loan
Name of lender Amount ($) Repayment Amount Per Week/Fortnight/Month
Investment Property Loans
You can enter up to FIVE property loans, simply press the (+) for another row.
Name of lender Amount ($) Repayment Amount Per Week/Fortnight/Month
Shares Loan
Name of lender Amount ($) Repayment Amount Per Week/Fortnight/Month
Investment Fund Loan
Name of lender Amount ($) Repayment Amount Per Week/Fortnight/Month
Car Loan
You can enter up to TWO Cars, simply press the (+) for another row.
Name of lender Amount ($) Repayment Amount Per Week/Fortnight/Month
Credit Card
You can enter up to FOUR Credit Cards, simply press the (+) for another row.
Name of lender Amount ($) Limit ($)
Store Card
You can enter up to FOUR Store Cards, simply press the (+) for another row.
Name of lender Amount ($)
Other Loans or Liabilities
You can enter up to FIVE other loans and liabiities, simply press the (+) for another row.
Name of lender Amount ($) Repayment Amount Per Week/Fortnight/Month

Founded in 1998. Our Experience is drawn from over 20 years in areas including accounting, taxation, business advisory, finance and property.

“ We want to let you know how delighted we have been with the service and skill you and your team have provided to us … Fred & Deanne ”

11 Kintail Road, Applecross Western Australia

Mercia | Taxation, Business & Finance Advisers

Name of lender	Amount ($)	Repayment Amount	Per Week/Fortnight/Month

Gross $$	Initials of Person

What is it?	Gross $$	Initials of Person

Initials of Owner	Amount ($)

Initials of Owner	Amount ($)