Lease application
1. Vehicle Selection
2. Customer Details
First Name *
Middle Name/s
Last Name *
Title *
MrMrsMissDr
Date of Birth *
Maiden Name
Gender
MaleFemaleOther
Relationship Status
De FactoDivorcedMarriedSingle
Drivers Licence Number
Drivers Licence State
New South WalesVictoriaQueenslandSouth AustraliaWestern AustraliaTasmaniaNorthern TerritoryAustralian Capital Territory
Drivers Licence Expiry Date
Drivers Licence Card Number
Passport Country
Passport Number
Passport Expiry Date
Medicare Card Number
Medicare Reference Number
Medicare Card Colour
BlueGreenYellow
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 *
CitizenPermanent ResidentOther
Photographic ID *
Drivers LicensePassport
Upload front and back photo ID *
Colour images only
3. Customer Address
Current Address
From
Owner / Tenant
BoardingRentingOwner
Previous Addresses
Different Mailing Address
YesNo
Mailing Address *
Phone Business
Email Business
Phone Home
Email Home
Phone / Mobile Number
4. Current Employer
Employment Status
Casually EmployedContractorFull Time EmployedPart Time EmployedSeasonalSelf-EmployedOther
Occupation Type
BenefitClericalExecutive
Date Started
Job Title
Employer Name
Entity Type
GovernmentLimited
Industry
Employer ABN
Established Date
Trading Address
5. Income
Income Status
Casually EmployedContractorFull Time EmployedN/APart Time EmployedSeasonalSelf-EmployedOther
Income Type
Base Salary and WagesChild SupportGovernment Benefits / PensionsInterest or DividendInvestment IncomeNet Business Income (Business Only)Other IncomeRegular CommissionRegular Overtime and AllowancesRental IncomeSpousal IncomeSpousal Maintenance
Income Description
Income Frequency
FortnightlyMonthlyWeekly
Annual salary (before tax not inc super) *
Upload 3 most recent payslips *
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.
6. Budget
Expenses *
1
2
3
1
Basic Living Expense
Frequency
AnnuallyMonthlyWeeklyDaily
Description
Amount
Basic Living Expense
Frequency
AnnuallyMonthlyWeeklyDaily
Description
Amount
Basic Living Expense
Frequency
AnnuallyMonthlyWeeklyDaily
Description
Amount
Basic Living Expense
Frequency
AnnuallyMonthlyWeeklyDaily
Description
Amount
Assets *
Liabilities *
1
2
3
1
Liability Type
Home LoanOther
Financier
Amount
Frequency
WeeklyFortnightlyMonthlyYearly
Status
Current
Expense Amount
Balance
Liability Type
Home LoanOther
Financier
Amount
Frequency
WeeklyFortnightlyMonthlyYearly
Status
Current
Expense Amount
Balance
Liability Type
Home LoanOther
Financier
Amount
Frequency
WeeklyFortnightlyMonthlyYearly
Status
Current
Expense Amount
Balance
Liability Type
Home LoanOther
Financier
Amount
Frequency
WeeklyFortnightlyMonthlyYearly
Status
Current
Expense Amount
Balance
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.
Submit Application
Basic plan
From $640 / m
- Electric vehicle
- Car maintenance
- Tyres
- Comprehensive insurance
- Registration
- CTP insurance