Data Collection Form
Please refrain from using symbols such as , %,@,* etc. Mandatory fields are identified with a red star.
Title
Please Select
Mr
Mrs.
Ms
Dr
First Name
*
Surname
*
DOB
/
Day
/
Month
Year
Date
Phone Number
Please enter a valid phone number.
Format: 0000-000-000.
Client Email Address
example@example.com
Client 2 Details (if applicable)
Title
Please Select
Mr
Mrs
Ms
Dr
First Name
Surname
DOB
/
Day
/
Month
Year
Date
Phone Number
Please enter a valid phone number.
Format: 0000-000-000.
Client Email Address
example@example.com
Client 1 Address
Number, Street name
*
Suburb
*
Post Code
*
State
*
Please Select
NSW
QLD
ACT
VIC
NT
WA
SA
TAS
Client 2 Address
If different from above
Number, Street name
Suburb
Post Code
State
Please Select
NSW
QLD
ACT
VIC
NT
WA
SA
TAS
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
*
Check Out
prev
next
( X )
Initial Overview
$9.90 AUD
$
9.90
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Submit
Thanks for submitting
We are looking forward to working with you.
Should be Empty: