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Application for Personal Loan
(Special Purpose Fund)
Please use this form to apply for a Personal Loan
Personal Details
Persons Name:
*
First name
Middle name
Last name
Persons Address:
Address line 1
Address line 2
City/Suburb
State/Territory
Postcode
Home phone:
(nnnn nnnn)
enter phone number as nnnn nnnn (no area code required)
Show on directory ?
Mobile:
(nnnn nnn nnn)
enter mobile number as nnnn nnn nnn
Email address
I wish to apply for an interest free personal loan.
Purpose of the loan:
*
Loan Amount Requested
(up to $3,000)
$
*
Personal reference (contact name & phone no of friend or relative not living with you that we may contact for reference
Reference Name:
*
Reference Address:
*
Reference Phone:
(nnnn nnnn)
Reference Mobile:
(nnnn nnn nnn)
Relationship to you:
*
Financial Assessment
Income Source:
Salary or wages (self) Monthly Income: $
Pension (self) Monthly Income: $
Salary or wages (partner) Monthly Income: $
Pension (partner) Monthly Income: $
Other Monthly Income :
1. identify other income type
specify type of other income
1. Monthly Income: $
2. identify other income type
specify type of other income
2. Monthly Income: $
3. identify other income type
specify type of other income
3. Monthly Income: $
Total Monthly Regular Income:
Notes:
Expenses:
Mortgage/Rent (Monthly Amount): $
Bank Loan(s) Amount Owed: $
Bank Loan(s) Monthly Payment: $
Other Loan(s) Amount Owed: $
Other Loan(s) Monthly Payment: $
Credit Card Accounts
1. Credit Card Amount Owed: $
1. Credit Card Monthly Payment: $
2. Credit Card Amount Owed: $
2. Credit Card Monthly Payment: $
Store Account's - White Goods, Computers, Furniture
Store Accounts Amount Owed: $
Store Accounts Monthly Payment: $
Utilities (Electricity/Gas) Monthly Payment: $
Telephone, Internet Monthly Payment: $
Netflix/Foxtel Monthly Payment: $
General Living Costs (food, clothes) Monthly Payment: $
Entertainment (cigarettes, outings) Monthly Payment: $
School Fees, Uniforms Monthly Payment: $
Insurance Payments Monthly Payment: $
Other (medical/chemist) Monthly Payment: $
BB Loan Repayment Monthly Payment: $
Please attach accompanying evidential documentation
*
MUST include INCOME STATEMENT and other evidential documentation
Wait..
Total Monthly Income: $
Total Monthly Expenses: $
Surplus/Deficit:
Deficit
Surplus
Monthly Amount: $
Surplus/Deficit:
Deficit
Surplus
Fortnightly/Weekly Amount: $
Bank Details and Loan Approval
For loan payment into your nominated bank account, please provide the following details:
BSB#
Account Name:
Account Number:
Witness Signature:
Clear
Verbally Signed
Application Date:
*
Form Page Break #1
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Terms and Conditions of Personal Loan
I have supplied the financial assessment required by Beyond Blindness (BB) indicating my ability to repay the loan.
I agree to repay the loan within the required period as per the attached schedule.
I understand that if I default on this undertaking that BB will suspend my access to other SPF benefits until such time as the loan plus any fees incurred to Beyond Blindness are repaid in full.
I also understand that if I default on the terms of this loan, I may be precluded from receiving further SPF benefits.
I agree to authorise my financial institution to transfer regular payments (minimum monthly payments) from my account to BB for the purpose of repayments of this loan after approval has been given. I will provide BB documentation to verify that I have set up for regular payments to be transferred electronically from my account to BB. I understand that no monies will be released to me until such documentation has been supplied.
I give permission to BB to obtain my location details from other blindness organisations should I default or move address without notifying BB.
I agree not to cancel, suspend, alter or defer any transfer request for the term of the loan without the written consent of BB.
NB: Please allow 7 days for processing of application
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