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	Loan Details

		Loan Amount Sought
		Loan Term Required
		What is the purpose of your loan?
		Are you a first home buyer?
		Have you found a property / item to finance?

Applicant Details

		Title						Title
		First Name						First Name
		Surname						Surname
		Home Phone Number						Home Phone Number
		Work Phone Number						Work Phone Number
		Mobile Phone Number						Mobile Phone Number
		Email Address						Email Address
		Street Number						Street Number
		Street Name						Street Name
		Street Type (e.g. Street, Road, Cresent)						Street Type (e.g. Street, Road, Cresent)
		Suburb						Suburb
		State						State
		What is the value of the property / item to be financed or refinanced?						What is the value of the property / item to be financed or refinanced?
		Are you currently employed?						Are you currently employed?
		What is your annual income?						What is your annual income?
		Who is your current employer?						Who is your current employer?
		Length of Employment?						Length of Employment?
		Are you self employed?						Are you self employed?
		Do you have a clear credit history? (If 'No' please detail in the comments box below)						Do you have a clear credit history? (If 'No' please detail in the comments box below)

Assets Statement

		Real Estate 1 (Suburb)						Estimated Market Value
		Real Estate 2 (Suburb)						Estimated Market Value
		Vehicle (s) Value						Bank Accounts (current balances)
		Investments / Shares						Superannuation
		Other Assets

Liability Statement

Mortgage Lender (1)

Amount Owing

Monthly Payment

Mortgage Lender (2)

Amount Owing

Monthly Payment

Personal Loan Lender (1)

Amount Owing

Monthly Payment

Personal Loan Lender (2)

Amount Owing

Monthly Payment

Credit Card Limits

Amount Owing

Monthly Payment

Store Card Limits

Amount Owing

Monthly Payment

Other Loan Lender (1)

Amount Owing

Monthly Payment

Other Loan Lender (2)

Amount Owing

Monthly Payment

General Notes

Comments

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Any advice does not take into account your personal needs and financial circumstances and you should consider whether it is appropriate for you. NationWide Finance recommends you read the Product Disclosure Statement and the Financial Services Guide before acquiring the product.