Loan Type* Loan Type* Consumer Loan Yamaha Blue Card Commercial Finance

Title* Title*MrMrsMsMissMasterDrProf

First Name*

Last Name*

Gender* Gender*MaleFemale

Email Address*

Mobile Phone*

Date of Birth

Marital Status* Marital Status* Single Married Defacto Divorced Widowed

Number of Dependants*

Drivers Licence Number*

Drivers Licence Issued By* Drivers Licence Issued By*ACTNSWNTQLDSATASVICWA

Drivers Licence Expiry Date

Permanent Resident* Permanent Resident* Yes No

Street Address 1 (PO Boxes not accepted)

Street Address 2 (PO Boxes not accepted)

City

State

Postcode

Country CountryAustraliaNew Zealand

Residential Status Residential Status Owned Renting Boarding

Months in Residence

Years in Residence

Previous Street Address 1 (PO Boxes not accepted)

Previous Street Address 2 (PO Boxes not accepted)

City

Previous State

Postcode

Country CountryAustraliaNew Zealand

Residential status Residential status Owned Renting Boarding

Years in Residence

Months in Residence

Current Employer Name

Occupation

Employer Phone Type Employer Phone TypeBusiness

Employer Phone Number

Employer Contact Number

Employment Type Employment Type Full Time Part Time Casual Self-employed Contractor

Monthly Income After Tax

Months Employed

Years Employed

Previous Employer Name

Previous Occupation

Employer Phone type Employer Phone typeBusiness

Previous Phone Number

Previous Contact Name

Employment Type Employment Type Full Time Part Time Casual Self-employed Contractor

Months Employed

Years Employed

Mortgage Financier

Mortgage Account Balance

Mortgage Monthly Repayment

Monthly Living Expenses (Not including Mortgage/Rent or other loan repayments)

Monthly Rent/Board

Other Type of Loan or Credit 1 Other Type of Loan or Credit 1Car LoanLine of CreditMarine LoanMotorcycle LoanPersonal Loan

Financier

Monthly Amount

Other Type of Loan or Credit 2 Other Type of Loan or Credit 2Car LoanLine of CreditMarine LoanMotorcycle LoanPersonal Loan

Financier

Monthly amount

Other Type of Loan or Credit 3 Other Type of Loan or Credit 3Car LoanLine of CreditMarine LandMotorcycle LoanPersonal Loan

Financier

Monthly Amount

Credit Card 1 Type Credit Card 1 TypeVisaMaster CardOther

Card Issuer

Credit Card Limit

Credit Card 2 Type Credit Card 2 TypeVisaMaster CardOther

Card Issuer

Credit Card Limit

Credit Card 3 Type Credit Card 3 TypeVisaMaster CardOther

Card Issuer

Credit Card Limit

Condition of Asset to be Financed Condition of Asset to be FinancedNewUsed

Manufacturer

Model

Year

Purchase Price

Deposit/Trade in Value

Balanced to be Financed

Term Term2 Years3 Years4 Years5 Years

Frequency Frequency FortnightlyMonthly

First Name of Next of Kin

Last Name of Next of Kin

Address

Contact

Relation to Primary Applicant

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