Lease Application

1. Vehicle Selection

Vehicle Make

Vehicle Model

Annual Kilometres *

Estimated Business Usage *

Registration

Vehicle Purchase Price (inc GST)

Vehicle Purchase Invoice

File name:

File size:

Insurance Policy

File name:

File size:

Insurance Invoice

File name:

File size:

2. Customer Details

First Name *

Middle Name/s

Last Name *

Title *

Date of Birth *

Maiden Name

Gender

Relationship Status

Drivers Licence Number

Drivers Licence State

Drivers Licence Expiry Date

Drivers Licence Card Number

Passport Country

Passport Number

Passport Expiry Date

Medicare Card Number

Medicare Reference Number

Medicare Card Colour

Medicare Card Expiry Date

Number of Credit Cards

Number of Dependents

Age of Dependent 1

Age of Dependent 2

Age of Dependent 3

Age of Dependent 4

Age of Dependent 5

Age of Dependent 6

Visa Status *

Photographic ID *

Upload front and back photo ID *

Colour images only

1	Photo * File name: File size:
1	Photo * File name: File size:

Add photo

3. Customer Address

Minimum 2 years history.

Current Address

From

Owner / Tenant

Previous Addresses

1

Address

From

To

Owner / Tenant

Add Address

Different Mailing Address

YesNo

Mailing Address *

Phone Business

Email Business

Phone Home

Email Home

Phone / Mobile Number

4. Current Employer

Employment Status

Occupation Type

Date Started

Job Title

Employer Name

Entity Type

Industry

Employer ABN

Established Date

Trading Address

5. Income

Income Status

Income Type

Income Description

Income Frequency

Annual salary (before tax not inc super) *

Upload 3 most recent payslips *

1	Payslip * File name: File size:
2	Payslip * File name: File size:
3	Payslip * File name: File size:
1	Payslip * File name: File size:

Privacy Disclosure Statement

I have opened and read the Privacy Disclosure Statement and agree to  the use of my personal information as described in the Statement.

Privacy Disclosure Statement

6. Budget

Expenses *

1	Basic Living Expense Frequency Description Amount
2	Basic Living Expense Frequency Description Amount
3	Basic Living Expense Frequency Description Amount
1	Basic Living Expense Frequency Description Amount

Add

Assets *

1	Asset Type Description Asset Amount
2	Asset Type Description Asset Amount
3	Asset Type Description Asset Amount
1	Asset Type Description Asset Amount

Add

Liabilities *

1	Liability Type Financier Amount Frequency Status Expense Amount Balance
2	Liability Type Financier Amount Frequency Status Expense Amount Balance
3	Liability Type Financier Amount Frequency Status Expense Amount Balance
1	Liability Type Financier Amount Frequency Status Expense Amount Balance

Add

Insurance

Would you like to apply for an insurance quote through our insurance partner, Mecurien.  Mecurien specialises in novated lease insurance and comes with gap cover as standard.

7. Acknowledgements

Acknowledgement *

I hereby declare that the information provided is true and correct. I also understand that any intentional dishonesty  may result in rejection of this application. Your application will be evaluated based on the information provided.  You acknowledge that the personal and credit-related information you provided in this application may be used,  stored or disclosed as permitted under the Privacy Act 1988 (Cth) and the Privacy (Credit Reporting) Code.

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