Mortgage Escape Australia

Data Collection Form

Please refrain from using symbols such as , %,@,* etc. Mandatory fields are identified with a red star.
Title
First Name*
Surname*
DOB

DayMonthYear
Date
Phone Number
Please enter a valid phone number.
Client Email Address
example@example.com
Client 2 Details (if applicable)
Title
First Name
Surname
DOB

DayMonthYear
Date
Phone Number
Please enter a valid phone number.
Client Email Address
example@example.com
Client 1 Address
Number, Street name *
Suburb*
Post Code*
State*
Client 2 Address

If different from above
Number, Street name
Suburb
Post Code
State
Income/s

Rental incomes is combined for both parties and discussed in terms of percentage subsequently. Family allowances are described as client 1 & 2 for identification purposes.
Client 1 Gross Salary / Wage*
$ Before tax annual income
Client 2 Gross Salary / Wage*
$ Before tax annual income
Rental Income
All properties combined rental income PER WEEK
Client 1 Centrelink A & or B + Maintenance Income (Tax Free)
$PER ANNUM
Client 2 (Centrelink A & or B + Maintenance Income (Tax Free)
$ PER ANNUM
Client 1 (Centrelink Other)
$ PER ANNUM
Client 2 (Centrelink Other)
$ PER ANNUM
Client 1 Other Income
$ PER ANNUM Before Tax
Client 2 Other Income*
$ PER ANNUM Before Tax
Assets & Liabilities
Home loan
Home Value*
$
Home Loan*
$
Interest Rate
%
Remaining Loan Term
Years
Vacant Land
Vacant Land Value*
$
Vacant Land Loan*
$
Interest Rate
%
Remaining Loan Term
Years
Investment Loan
Investment Property Value*
$
Investment Property loan*
$
Interest Rate
%
Remaining Loan Term
Years
Living expenses
MONTHLY - Everything other than Loan / Debt payments - NOTE: If unknown the program will assume a percentage of combined after tax income. This will amount from time to time based on assumed cost of living issues.
Personal Debts

Personal Loans, Credit Cards etc
Client 1 Motor Vehicle Loan*
Please enter Zero (0) if not applicable
Client 2 Motor Vehicle Loan*
Please enter Zero (0) if not applicable
Interest Rate
%
Interest Rate
%
Client 1 Store Loan/s*
Combined - Zero (0) if not applicable
Client 2 Store Loan/s*
Combined - Zero (0) if not applicable
Interest Rate
%
Term (if known)
Client 1 Credit Card Balance/s*
Combined - Zero (0) if not applicable
Client 2 Credit Card Balance/s*
Combined - Zero (0) if not applicable
Interest Rate
%
Term (if known)
Months
Client 2 Personal Loan/s*
All Loans - Combined
Client 1 Personal Loan/s*
All Loans - Combined
Interest Rate
%
Remaining Term
Years
Combined Cash available*
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Initial Overview
$9.90AUD Quantity

Total

$0.00AUD
Thanks for submitting

We are looking forward to working with you.
Should be Empty:

Data Collection Form

Client 2 Details (if applicable)

Client 1 Address

Client 2 Address

Income/s

Assets & Liabilities

Home loan

Vacant Land

Investment Loan

Personal Debts

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