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ASSETS & LIABILITIES FORM
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HIA
MBA
How did you hear about us?
Google
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Referral
EQUIPMENT LEASE:
CHATTEL MORTGAGE
FINANCE
LEASE
Term
RESIDUAL
Y
N
Business Name
Company
Partnership
Sole Trader
Trust
Trading Name
ABN
ACN
Business Address
Email
Business Phone No
Nature of Business/Occupation
Yrs Trading
Accountant Firm
Contact Name
Contact No
Address
Director
Partner
Sole Trader
Spouse
Male
Female
Married
Defacto
Single
Other
Dependents
Title
Ms
Mrs
Miss
First Name
Surname
Middle Name
D.O.B
D/license No
Exp Date
Mobile
Home
Email
Current Address
Suburb
State
Post Code
Time at Address
years
months
Owner
Mortgage
Renting
Boarding
Work Provided
ASSETS
House (Worth $)
Other Properties (Worth $)
Motor Vehicle (Worth $)
Other Vehicle (Worth $)
Boats/Caravan (Worth $)
Cash in Bank (Worth $)
Superannuation (Worth $)
Home Contents (Worth $)
Shares (Worth $)
Other (Worth $)
LIABILITIES
Mortgage/Rent
Lender
$Limit
$Owing
$Mthly Pymnt
Mortgage
Lender
$Limit
$Owing
$Mthly Pymnt
Car Loan
Lender
$Limit
$Owing
$Mthly Pymnt
Other Loan
Lender
$Limit
$Owing
$Mthly Pymnt
Personal Loan
Lender
$Limit
$Owing
$Mthly Pymnt
Credit Cards
Lender
$Limit
$Owing
$Mthly Pymnt
Store Cards
Lender
$Limit
$Owing
$Mthly Pymnt
Other
Lender
$Limit
$Owing
$Mthly Pymnt
Send
