Personal Details

Please provide a breakdown of all the amounts you receive and frequency. Do not enter an amount which is a total of all income. E.G. John - $500 weekly Mary - $1,200 fortnightly Boarder - $120 weekly

Please provide details of your current payments and the frequency of these payments

Please list all other loans and include the following information for each one. Lender, repayment amount and frequency, balance owing, (include interest rate if known) E.G. BNZ Personal loan $240 fortnightly balance is $6300 interest rate 14.95%

If any of your debts have payments overdue please provide a summary of the current status of your debts including your mortgage or rent payment. If everything is up to date simply place 'Up tp date' below. E.G. Car loan 1 month overdue, everything else is up to date.

Please provide any other financial information below that you believe would be helpful for us to know.