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EM FINANCE CORPORATION Pty Ltd - Application
Suite 9, 2 Kochia Lane, Lindfield NSW 2070 • PO Box 207, Pymble NSW 2073 • Telephone: (02) 9416 4999 Facsimile: (02) 9416 2999 Email: finance@emarketing.au.com
DEALERS COMPANY NAME
SALES CONSULTANTS FULL NAME
LOAN AMOUNT REQUESTED
LOAN TERM (MONTHS)
% RATE
LOAN PURPOSE
EMPLOYMENT & INCOME INFORMATION
BORROWER 1: SURNAME MR / MRS / MS / MISS
FULL GIVEN NAMES
DATE OF BIRTH
AGE
DRIVER'S LICENCE (BORROWER 1)
BORROWER 2: SURNAME MR / MRS / MS / MISS
FULL GIVEN NAMES
DATE OF BIRTH
AGE
DRIVER'S LICENCE (BORROWER 2)
HOME PHONE NUMBER (INCLUDE AREA CODE)
MARITAL STATUS
DEPENDENTS
MOBILE
ID CONFIRMED (AGENT’S SIGNATURE)
No.
STREET ADDRESS
TOWN / SUBURB
POSTCODE
YEARS / MONTHS
No.
PREVIOUS ADDRESS - PLEASE PROVIDE AT LEAST3 YEARS HISTORY
TOWN / SUBURB
POSTCODE
YEARS / MONTHS
RENTING
BOARDING
BUYING
FULLY OWNED
PAYMENT
/ WEEK
LANDLORD / MORTGAGEE
CONTACT PHONE NUMBER
EMPLOYMENT & INCOME INFORMATION
BORROWER 1 - EMPLOYER COMPANY NAME
LOCATION
WORK PHONE NUMBER
OCCUPATION
YEARS / MONTHS
TAKE HOME PAY
/ WEEK
BORROWER 1 - PREVIOUS EMPLOYER (PLEASE PROVIDE AT LEAST 3 YEARS HISTORY)
WORK PHONE NUMBER
OCCUPATION
YEARS / MONTHS
BORROWER 2 - EMPLOYER COMPANY NAME
LOCATION
WORK PHONE NUMBER
OCCUPATION
YEARS / MONTHS
TAKE HOME PAY
/ WEEK
BORROWER 2 - PREVIOUS EMPLOYER (PLEASE PROVIDE AT LEAST 3 YEARS HISTORY)
WORK PHONE NUMBER
OCCUPATION
YEARS / MONTHS
OTHER INCOME - SHOW TYPE AND / OR SOURCE
TOTAL AMOUNT RECEIVED
IF GOVERNMENT BENEFIT, SHOW HOW CONFIRMED
CONFIRMATION SIGHTED (AGENT’S SIGNATURE)
MOTOR VEHICLE DETAILS
CAR MAKE, MODEL & YEAR
FINANCED OR OWNED
NAME OF FINANCIER
MONTHLY REPAYMENTS
APPLICANTS ESTIMATED MONTHLY LIVING EXPENSES
CREDIT DETAILS
(Please show all current accounts and all other monthly commitments)
BANKCARD
VISA
MASTERCARD
OTHER
CREDIT CARD COMPANY (WPAC / ANZ / NAB / AMEX / ETC)
CREDIT LIMIT
MONTHLY REPAYMENTS
NAME OF BANK, FINANCE Co., CREDIT UNION, RENTAL COMPANYS
LOCATION
APPROXIMATE BALANCE
MONTHLY REPAYMENTS
NAME OF BANK, FINANCE Co., CREDIT UNION, RENTAL COMPANYS
LOCATION
APPROXIMATE BALANCE
MONTHLY REPAYMENTS
PERSONAL REFERENCES (Please provide full details for 2 relatives NOT living with you)
FULL NAME
FULL ADDRESS
PHONE NUMBER
RELATIONSHIP
FULL NAME
FULL ADDRESS
PHONE NUMBER
RELATIONSHIP
PRIVACY ACT ACKNOWLEDGEMENT AND AUTHORITY
TO: EM FINANCE CORPORATION PTY LIMITED ACN 097 851 324 (“EMFC”) - I give the following consents to EMFC;
EMFC AND A CONSUMER OR COMMERCIAL CREDIT REPORTING AGENCY: To the extent allowed by the Privacy Act, I consent to EMFC obtaining from or providing to any consumer or commercial credit reporting agency information about me for the purpose of:
assessing my application;
collecting any overdue payments from me;
keeping my information file accurate and up-to-date as required by the Privacy Act.
The information which may be given to a credit reporting agency includes:
Identity particulars and the fact that I have applied for credit and the amount;
The fact that EMFC is a credit provider to me;
The credit provided to me by EMFC has been paid or otherwise discharged;
Payments which become overdue more than 60 days, and for which collection action has commenced, and advice that the payments are no longer overdue;
In specified circumstances, that in the opinion of EMFC I have committed a serious credit infringement;
Cheques drawn by me which have been dishonoured more than once.
I acknowledge that delinquent or overdue amounts can be given to collection agencies I give EMFC authority to assess my application at an amount different to that applied for and for which approval would be given.
EMFC AND ANOTHER CREDIT PROVIDER:
I consent to EMFC obtaining information about me from, or providing that information to another credit provider for the purpose of assisting EMFC or the other credit provider in assessing any credit application by me, or in admistering or enforcing my account with EMFC or the other credit provider.
EMFC AND MY BANK:
For the purpose of correctly identifying the bank account from which loan repayments are to be made, I consent to EMFC obtaining from my bank, confirmation of my Bank- State-Branch (BSB) and account number details.
CONSENT FOR EMFC TO OBTAIN CONFIRMATIONS:
If EMFC considers it relevant in assessing my application, I consent to EMFC obtaining confirmation of my income, employment and / or residential information.
BORROWER 1 - SIGNATURE
DATE SIGNED
BORROWER 2 - SIGNATURE
EMFC AND YOUR ACCOUNTANT (For Self Employed applicants only) I hereby instruct my accountant to release any relevant information in order to expedite this application.
ACCOUNTANTS NAME
PHONE NUMBER
ACKNOWLEDGMENTS
1. I certify that the information I have given on this form is complete and correct. 2. I am not a registered bankrupt nor have I been served a Writ of Execution.
BORROWER 1 - SIGNATURE
DATE SIGNED
BORROWER 2 - SIGNATURE
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