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Purpose for loan:
To purchase a property:	$	Costs to be financed:	$
Refinance loan(s):	$	Other: (specify)	$
Bridging:	$	Less own funds:	$
Construction:	$	Total Loan required:	$

Applicant 1 Borrower Guarantor
Personal Details
Existing customer?	Yes No
Family name:	* Please enter your family name.
Given names:	* Please enter your first name. Please enter your given name(s).
Title:
Sex:	Male Female
Date of birth:	dd mm yy *
Marital status:	Single Defacto Married Divorced
Dependents:	Number:
	Age/s:
Driver's licence No:
Home phone:	* Please enter your phone number.
Work phone:
Mobile phone:
Fax:
Email Address:	* Please enter your email address. Invalid email address.
Preferred contact method:	Email Fax Phone Snail Mail
Address Details
Current address:	*
Suburb:	*
State:	*
Postcode:	*
Time at address:	Years Months
Postal address: (if different to above)
Postal Suburb:
Postal State:
Postcode:
New address after settlement: (if different to above)
New Suburb:
New State:
New Postcode:
If you have lived at your current address for less than three years, please complete below...
Previous address:
Previous suburb:
Previous state:
Previous postcode:
Time at prev address:	Years Months
Employment Details
Current employer:
Name:
Address:
Position:
Industry:
Employee type:
Taxable Income:	$ (per year)
Time at current Employment:	Years Months
If less than three years please indicate previous employment...
Employer:
Name:
Address:
Employer:
Name:
Address:
Time:	Years Months

Applicant 2 Borrower Guarantor
Personal Details
Existing customer?	Yes No
Family name:
Given names:
Title:
Sex:	Male Female
Date of birth:	dd mm yy
Marital status:	Single Defacto Married Divorced
Dependents:	Number:
	Age/s:
Driver's licence No:
Home phone:
Work phone:
Mobile phone:
Fax:
Email Address:
Preferred contact method:	Email Fax Phone Snail Mail
Address Details
Current address:
Suburb:
State:
Postcode:
Time at address:	Years Months
Postal address: (if different to above)
Postal Suburb:
Postal State:
Postcode:
New address after settlement: (if different to above)
New Suburb:
New State:
New Postcode:
If you have lived at your current address for less than three years, please complete below...
Previous address:
Previous suburb:
Previous state:
Previous postcode:
Time at prev address:	Years Months
Employment Details
Current employer:
Name:
Address:
Position:
Industry:
Employee type:
Taxable Income:	$ (per year)
Time at current Employment:	Years Months
If less than three years please indicate previous employment...
Employer:
Name:
Address:
Employer:
Name:
Address:
Time:	Years Months

Statement of Assets (What you own) For joint applications please combine assets
Properties Owned
#	Property Location	Monthly Income	Estimated Value
1		$	$
2		$	$
3		$	$
Vehicles Owned
#	Year / Make		Estimated Value
1			$
2			$
Bank account/term deposit / shares / other investments
#	Institution	Monthly Income	Estimated Value
1		$	$
2		$	$
3		$	$
4		$	$
5		$	$
Superannuation
#	Institution		Present Value
1			$
2			$
Home Contents Insurable
Insurance Company			Present Value
			$
Other Assets
#	Description	Monthly Income	Estimated Value
1		$	$
2		$	$
3		$	$
Statement of Liabilities (What you owe) For joint applications please combine liabilities
Mortgages
#	Mortgage to	Monthly Payment	Amount Owing
1		$	$
2		$	$
3		$	$
Lease / hire purchase / personal loans / other liabilities
#	Description	Monthly Payment	Amount Owing
1		$	$
2		$	$
3		$	$
4		$	$
Credit cards and credit accounts
#	Company / Type	Limit	Amount Owing
1	/	$	$
2	/	$	$
3	/	$	$
Rent
Real Estate / Landlord			Rent Per Month
			$
Tax / Provisional Tax
Description			Rent Per Month
			$

Applicant(s) must read and agree to the terms and conditions listed below before continuing.

Terms and Conditions
Pfeiffer Finance Privacy and credit information & Privacy act authorizations/agreement Authorization to act on behalf of individuals In compliance with the commonwealth Privacy Act 1998, parties to a finance application should complete and give this authority to the below name Introducer/Broker for the purpose of the Privacy Act. Name of Introducer: Pfeiffer Finance 1. Acknowledgment of Disclosure of Credit information to a Credit reporting agency. I/We acknowledge that section 18F(8) (C ) of the Privacy Act allows a credit provider which the above named introducer may approach in arranging my / our finance (hereinafter the Approached Credit Provider), to give a credit reporting agency certain personal information about my/our application for finance. The Information which may be given to an agency is covered section 18E (1) of the Act and includes: · Such permitted particulars about me/us which allows me/us to be identified.; · The fact that I/We have applied for finance and the amount; · The fact that the above named credit provider is a current credit provider to me/us; · Payments which have become overdue more than sixty days, and for which collection action has commenced; · Advise that payments are no longer overdue; · Cheques drawn my me/us for and amount not less than $100, which have been dishonoured more than once; · In specified circumstances, that in the opinion of the above named credit provider, I/We have committed a serious infringement; · Information as to court judgements against me. Information as to bankruptcy proceedings against me; · That finance provided to me/us by the above named credit provider has been paid or otherwise discharged. By virtue of this declaration, I/We understand that above name introducer has informed me/us of the disclosure policy to a credit reporting agency if information about me/us by Approached Credit Providers and so authorise such disclosures. 2. Agreement/Authority for Credit Provider to Perform Certain Permitted Actions Concerning a Finance Application or Transaction. I/We agree that if it is considered relevant in assessing my/our application for personal credit, the Approach Credit Provider may obtain a report about my/our commercial activities or commercial credit worthiness from a business, which provides information about the commercial credit worthiness of persons (section 18L(4)). I/We agree that if it is considered relevant in assessing my/our application for commercial credit, the Approach Credit Providers may obtain from accredit reporting agency a credit report containing personal credit information about me/us (section 18K (I) (b)). I/We agree that the approached Credit Provider may give to and seek providers name in the accompanying finance application and any credit providers that may be named in a personal or commercial credit report I Issued by a credit reporting agency or a commercial credit reporting agency respectively, information about my/our personal or commercial credit arrangements; I/We understand that this information can include any information about my/our credit worthiness, credit standing, credit history, credit capacity that credit providers are allowed to give or receive from each other under the Privacy Act (Section 1BN (1) (b)). 3. Authorization to act on behalf of individuals For the purpose of arranging the finance which is the subject of my/our application, the details of which appear below, I/We authorize the above named introducer to obtain a report about my/our consumer or commercial credit worthiness from a credit reporting agency or a credit reporting business or from a credit provider named in this application or referred to in such reports (section 18N(1)(ga)). I/We also authorize the above named introducer to pass on the above-obtained reports to such credit providers as are appropriate, for their consideration of this application. I/We authorize the above named Introducer to give and to receive from such parties as are necessary to the arranging of this finance, such as personal information about me/us which is necessary to the arrangement. PRIVACY STATEMENT Pfeiffer Finance is a business offering many different categories of Financial products in Mortgage, Commercial, Business and consumer finance, finance brokerage. We collect personal information from our clients so we can properly assess our clients application for Finance, provide specific products for our clients, assess our clients needs and improve our products and services. If this information is not provided or we can not assess this information we may not be able to properly assess our clients application and approve finance to them. Pfeiffer Finance is determined to protect the security of our clients personal information. As part of the Pfeiffer Finance process we will provide personal data to related entities with Pfeiffer Finance. We will not pass personal information on to unrelated third party businesses unless that business is being approached by Pfeiffer Finance on behalf of our client to arrange financial contracts or other related agreements (All these businesses operate under the same Privacy rules as Pfeiffer Finance upon request, we can arrange for a copy of their Privacy Statement to be forwarded to you). If we have any doubt as to whether or not you have authorized the release of that privacy information we will contact you. From time to time Pfeiffer Finance may use personal information to make product-related offers to our clients. You may choose not to receive this information indication below. A client may contact Pfeiffer Finance on 02 4961 0187 or 0414 562103, or in writing to our address at PO Box 72, Carrington NSW, or via email at info@pfeifferfinance.com.au to arrange to : (a) Access the personal data that we hold about them (b) Change their mind at any time about receiving products related material. (c) Obtain a copy of Privacy Policy. Pfeiffer Finance I Agree
You must read agree to the terms and conditions before submitting this form.

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