Client Information Form

Welcome to our Client Information Form
In order for us to provide you with high quality credit advice please complete our secure client information form. All data is encrypted and only authorised staff will have access to your supplied information.

How long will this take?

About 10 - 15 minutes. Try to be accurate but it does not need to be absolutely exact to the last dollar.

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If you have any questions please contact us on 1800 512 138 or by email at info@xcelleratefinance.com.au

Many thanks,

The team at Xcellerate Finance
APPLICATION SUMMARY
Date*

DayMonthYear
Date
Brokerage name
Brokerage email
example@example.com
Who referred you to us / how did you hear about us?*
Have you been referred to a specific broker within our team?*
Loan purpose*
No. of applicants*
Property value/price*
Est. loan amount $*
YesNo
What type of property does this application relate to?*
e.g. Apartment, townhouse, house, vacant land, etc.
EstablishedTo be builtNewly built/off-plan
NoYes

APPLICANT 1

Individual
Full Name*

TitleFirst NameMiddle NameLast Name
Preferred name
Date of birth*

DayMonthYear
Date
E-mail*
example@example.com
Alternative E-mail
example@example.com
Mobile phone*
Home phone
Work phone
Gender*
Marital status*
Residency status*
Country of residency*
No. of dependents*
Name*
Date of birth*

DayMonthYear
Date
Name*
Date of birth*

DayMonthYear
Date
Name*
Date of birth*

DayMonthYear
Date
Name*
Date of birth*

DayMonthYear
Date
Current address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Housing situation*
Date moved in?*

DayMonthYear
Date
Previous address 1
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Housing situation*
Date moved in?*

DayMonthYear
Date
Previous address 2
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Housing situation*
Date moved in?*

DayMonthYear
Date
Previous address 3
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Housing situation*
Date moved in?*

DayMonthYear
Date
No. of app. 1 addresses*
Applicant 1 Next of kin details (in Australia and not living at the same address as you)
Next of kin name*

First NameLast Name
Next of kin address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Next of kin phone*
Next of kin relationship to you*
Your mother's maiden name*

Applicant 1 Employment History
Current position
Annual gross salary/self-employed income*
Family tax benefit A & B income per fortnight*
Other Centrelink income per fortnight*
Monthly child support income *
Monthly child support expense*
Other income (except rental income) per month*
Employment status*
Occupation*
Employer name*
ABN*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
HR/payroll contact*

First NameLast Name
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
Previous position 1
Employment status*
Occupation*
Employer name*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
Previous position 2
Employment status*
Occupation*
Employer name*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
Previous position 3
Employment status*
Occupation*
Employer name*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
No. employers for app. 1*

COMPANY/TRUST APPLICANT
Full registered name*
ABN*
ACN*
Trading name*
Business activity*
Registered in (state)*
Date incorporated*

DayMonthYear
Date
PrivatePublic
Trust name*
Contact person
Full name*

TitleFirst NameMiddle NameLast Name
Preferred name
E-mail*
example@example.com
Alternative E-mail
example@example.com
Mobile phone*
Home phone
Work phone
Registered address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Principal place of business
YesNo
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Number of directors*
Director 1 name*
Ownership %*
Director 2 name*
Ownership %*
Director 3 name*
Ownership %*
Director 4 name*
Ownership %*
Director 5 name*
Ownership %*

APPLICANT 2

Company/Trust
Full registered name*
ABN*
ACN*
Trading name*
Business activity*
Registered in (state)*
Date incorporated*

DayMonthYear
Date
PrivatePublic
Trust name*
Contact person
Full name*

TitleFirst NameMiddle NameLast Name
Preferred name
E-mail*
example@example.com
Alternative E-mail
example@example.com
Mobile phone*
Home phone
Work phone
Registered address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Principal place of business
YesNo
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Country*
Number of directors*
Director 1 name*
Ownership %*
Director 2 name*
Ownership %*
Director 3 name*
Ownership %*
Director 4 name*
Ownership %*
Director 5 name*
Ownership %*

Applicant 2 Employment History
Current position
Annual gross salary/self-employed income*
Family tax benefit A & B income per fortnight*
Other Centrelink income per fortnight*
Monthly child support income *
Monthly child support expense*
Other income (except rental income) per month*
Employment status*
Occupation*
Employer name*
ABN*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
HR/payroll contact*

First NameLast Name
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
Previous position 1
Employment status*
Occupation*
Employer name*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
Previous position 2
Employment status*
Occupation*
Employer name*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
Previous position 3
Employment status*
Occupation*
Employer name*
Employer address
Unit
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Employer contact phone number*

Area CodePhone Number
Date started*

DayMonthYear
Date
No. employers for app. 2*

ASSETS & LIABILITIES
Property values and liabilities

Rows	Value $	Lender	Loan balance $	Monthly repayment $	Fixed / Variable?	Current rate %
Home
Vacant land
Property 2
Property 3
Property 4
Property 5
Property 6
Property 7
Property 8
Property 9
Property 10

Other properties owned
Prop2value
Prop3value
Prop4value
Prop5value
Prop6value
Prop7value
Prop8value
Prop9value
Prop10value
Property 2 address
Property 2 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 3 address
Property 3 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 4 address
Property 4 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 5 address
Property 5 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 6 address
Property 6 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 7 address
Property 7 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 8 address
Property 8 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 9 address
Property 9 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Property 10 address
Property 10 weekly rental income*
Unit*
Street no.*
Street name*
Street type*
Suburb*
State*
Postcode*
Vehicles owned

Rows	Make	Model
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5

Rows	Year
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5

Rows	Value	Loan balance	Monthly payment
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5

Rows	Lender
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5

Other assets

Rows	Value
Cash savings
Personal effects / home contents
Superannuation
Shares
Other investments
Other assets

Loans other than home and vehicle

(include ALL debts even if you don't think they are important or they are part of your business)

Rows	Monthly repayment	Balance owed
1 Personal loan
2 Personal loan
3 Personal loan
4 Other
5 Afterpay
6 Certegy
7 Zipmoney/pay

Rows	Lender name
1
2
3
4

Store and credit cards

(include ALL cards even if you don't use them and/or they have zero balance)

Rows	Lender
Card 1
Card 2
Card 3
Card 4
Card 5
Card 6
Card 7
Card 8
Card 9
Card 10

Rows	Limit	Balance
Card 1
Card 2
Card 3
Card 4
Card 5
Card 6
Card 7
Card 8
Card 9
Card 10

Rent/Board Expenses
How much do you pay per week for board/rent $?

CREDIT GUIDE & PRIVACY DISCLOSURE CONSENT
Yes, I/we appoint the Broker or Connective to obtain a credit report on my/our behalf
Applicant 1*

First NameLast Name
Date*

DayMonthYear
Date
Applicant 1 email
example@example.com
Applicant 1 mobile
Applicant 1 signature*
Applicant 2*

First NameLast Name
Date*

DayMonthYear
Date
Applicant 2 email
example@example.com
Applicant 2 mobile
Applicant 2 signature*
Consent to receive marketing Information - you consent to us doing so & we may provide you with information from time to time about new products and services available to you from us or other businesses with whom we have a relationship. Your consent to our providing this information to you will be implied unless you notify us that you do not wish to receive this information.
I/we do not wish to receive marketing information
Consent to receive documents electronically - you consent to us providing you with documents by electronic communication, you confirm that paper documents may no longer be given, and electronic communications must be regularly checked for documents. Consent to the giving of documents by electronic communication may be withdrawn at any time.
I/we do not wish to receive documents electronically
Please be patient, it can take up to a minute to send us all of your information. Once complete, this page will refresh to our needs analysis questionnaire.
Should be Empty: