Academy Of Counselling

Easy Finance Available

Please complete this form. Mac Lifestyle will assess your application and contact you directly.

* Required

1. Personal Details
Title:	Surname: *	Given Name: *
Please Select DR MISS MR MRS MS
Home Phone:	Work Phone:	Mobile Phone:
Number of Depandants:	Ages (eg: 3, 5, 11):	Email Address: *
-- Please select -- One Two Three Four Five Six Seven Eight
Loan Amount: (inc $390 setup fee)	Introducer:	Driving License Number:
$5,000.00	Academy of Counselling
Date Of Birth: (DD/MM/YYYY)	Sex:	Maitial Status:
	Male Female	-- Please select -- Single Defacto Married Divorced
2. Income Details
Net Monthly:	Job Description:	Occupation:	Name of Employer:	How Long:
	-- Please select -- Full time Part time Casual Self employed			yrs mnths
Work Street Address:	Suburb:	State:
		-- Please select -- ACT NSW NT QLD SA VIC WA
3. Assets
	Owner:	Market Value:	Investment Property Address:	Managed By:
Personal Home	Self Joints
Investment Property	Self Joints			Please Select Real Estate Self Managed
Bank Account Owner:	Bank Balance:	Bank Institution:
Self Joints		Please Select ANZ Commonwealth National St George Westpac Other
4. Other Assets
	Owner:	Policy Number:	Market Value:
Motor Vehicle	Self Joints
Home Content:	Self Joints
Other	Self Joints
5. Liabilities
	Owner:	Company:	Credit Limit:	Balance Owing:
Credit Card 1:	Self Joints
Credit Card 2:	Self Joints
Credit Card 3:	Self Joints
Credit Card 4:	Self Joints
	Owner:	Mortgagor:	Balance Owing:	Monthly Repayment:
Home Loan	Self Joints
Investment Property:	Self Joints
Personal Loan:	Self Joints
Car Loan:	Self Joints
Other Loan:	Self Joints
6. Living Arrangement
Current Living	Current Address	If Renting, Real Estate Name/Suburb	Weekly Rent	Time At Address
Please Select Owner Rental Boarding Sharing
Previously Living	Previous Address If Less Than 3 Years At Current Address	If Renting, Real Estate Name/Suburb	Weekly Rent	Time At Address
Please Select Owner Rental Boarding Sharing
Reference / Next of Kin Name:	Reference / Next of Kin Address:	Reference / Next of Kin Home Number ONLY:
7. Credit History
Have you ever been bankrupt or have any paid or unpaid defaults or court judgements?  No Yes
If yes, please provide details
Privacy Authorisation
MAC Lifestyle values and respects your rights to privacy of personal information. In order to assess your application please be aware of the following information and provide us with your consent to collect and use your information. Without this consent we may not be able to consider your application. Please read our privacy authorisation form.
I have read and understood the privacy statement in this form and I consent to the collection, use and disclosure of personal information in accordance with the privacy statement.
Do you agree to a Veda (CRAA) check?  Yes No
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