How much would
you like to borrow ?

Loan Info

Loan Amount

Loan Period Weeks

Weekly Repayment

0.00

Personal Details

General Information

First Name*

Middle Name

Last Name*

Title*

Date of Birth*

Gender*

Mobile Phone*

Verification Code*

Home Phone

Email*

No of Dependents*

Marital Status*

Additional Personal Details

Emergency Contact Details

Contact Person Full Name*

Contact Person Number*

Relationship*

Address & ID Details

ID & Details*

Passport no*

Country of Issue*

Residential Address*

If your address does not match any auto fill results, please choose the closest match and change mannually below.

Street Number*

Street Name*

Suburb*

State*

Postal Code*

Time at current address*

Residential Status*

Employment Information

Employment Status*

Employment Start Day*

Occupation*

Company Name*

Company Address*

Company Phone*

Next Pay Date*

Income Frequency*

Second Employer Details

Do you have another job*

Employment Status*

Next Pay date*

Other Company Name*

Other Company Address*

Other Company Phone*

Occupation*

Income Frequency*

Employment start day*

Loan Particulars

Loan Info

Purpose of Loan*

More Detail for Loan*

Income

Monthly income after tax(AUD)-Dollars*

Monthly Benifit centrelink/Pension*

Expense

Monthly Mortgage/ Rent (Including borading cost, etc)*

Monthly Food & Entertainment(food,entertainment,etc.)*

Monthly Home & Utility Expenses ( Gas, Water, Electric, TV & internet…)*

Monthly personal expenses (Gymmembership, school fee, child care, medical …)*

Monthly Loan repayment ( Small, Medium And other loan)*

Monthly Travel expenses ( Bus, Train,petrol vehicle running cost…)*

Monthly Insurance ( healthm housem carm petm other...)*

Credit card limit*

Client Declaration and Authorization

Declaration

Do you have any gambling habit?*

No Yes

Can you make sure you will be able to repay this loan on time?*

Yes No

Can you make sure you have no unpaid credit defaults ?*

Yes No

I agree that all the information I have given is true and current*

Yes No

Can you cut back on your non-essential spending while you repay this loan?*

Yes No

I confirm I am not bankrupt or on a Part IX Debt Agreement?*

Yes No

How did you hear about us?*

How do you evaluate your own credit rating?*

Authorization

I have read and understood the Credit Guide and understood the Privacy and Credit Reporting Notice.

I also have read and understood the Electronic Communication Consent and Authority and make all consents and acknowledgements it contains including communicating with you electronically.

I understand that by completing this application I authorize Australian Synergy Finance Pty Ltd to obtain a copy of my full credit file.

If my application is unsuccessful, I would like to be referred to a third party who may be able to assist me.

How much would you like to borrow ?

Weekly Repayment

Personal Details

Additional Personal Details

Loan Particulars

Client Declaration and Authorization

How much would
you like to borrow ?