Submitting a Financial Budget

In order for us to fully understand your current financial status, we need to know more about your financial situation. As such please complete the following survey, filling in all possible details.

Once you have completed this survey we will send you an automated response to confirm we have received it. Once we have reviewed this survey we will be able to contact you to discuss the matter further.

If you would like to update your details after you have submitted this survey or have a question, feel free to contact us on 1300 799 511 quoting your reference.

Please try to answer all questions. If it does not apply to you, put N/A and the reason it does not apply.

    Personal Details

    First name

    Last Name

    Drivers License Number

    Date of birth

    Postal Address

    Phone Numbers (At least one of these is required)




    Reference Number

    Email Address (automated response will be sent here)

    Your Assets

    Do you own, rent or board at your current address?

    Name of landlord/real estate agent

    Phone number of landlord/real estate agent

    Address of landlord/real estate agent

    Do you own or are you buying any land or building?

    Do you own or are you buying a motor vehicle?

    Are you owed any money?

    Are you an owner or do you have an interest in any business?

    Your Income

    Are you employed?
    You will be required to provide proof of your income e.g. a pay slip. This can be mailed to our office, attached below or sent via email to with your reference number

    Will you be starting employment in the near future?

    Do you have a different source of income? If yes provide details

    How much cash money do you have readily available?

    Have you any personal property or assets not previously mentioned? If so, give details

    If any of your assets or personal property are held with another person, provide the name and address of this person.

    Your Expense

    Give details of your expenses on a weekly basis.





    House & Contents Insurance

    Municipal & Water Rates


    Education Expenses


    Entertainment Expenses

    Fuel Expenses

    Car Expenses (Includes registration, insurance & maintenance)

    Other Expenses

    Loan Repayments (Give details of the loan and the balance owing, if multiple separate with ';')

    Credit Card Repayments (Give details of each card and the balance owing, if multiple separate with ';')

    Any other unpaid fines/debts against you (Give details of each and the outstanding balance, if multiple separate with ';')


    Family Details

    Are you single/married/living in a de facto relationship?
    SingleMarriedDe Facto

    How many dependents do you have in your care?

    What is their relationship to you and what are their ages? (if multiple, separate with ';')

    Your Offer

    We appreciate that you may not be able to pay the full amount in one payment. Please include your offer to pay this debt.

    Lump Sum Your offer to pay off in one payment)

    Other Comments

    Terms and Conditions

    I certify that I have read and accept the Terms and Conditions

    Attach Proof of income here