Financial Statement - Police Credit Union

Please complete the Financial Statement with as much detail as possible so we can best determine how we may be of assistance.
Reason for Assistance*
Please outline the reason(s) for your request for assistance
Repayment Proposal*
Please outline the repayment proposal that you would like us to consider. What are you able to pay?
Resumption of Regular Payments*
Please explain how and when you expect to resume your regular repayments.
Number of borrowers*
- Individual
- Joint

Borrower 1
Borrower 1 – Personal Details
Name*
First name * Middle name Last name *
Member number*
Residential address*
Street addressAddress line 2SuburbStatePostcode
Postal address
Same as residential address
Street addressAddress line 2SuburbStatePostcode
Preferred contact number*
Number of dependants*
Age of dependant #1*
Age of dependant #2*
Age of dependant #3*
Age of dependant #4*
Age of dependant #5*
Age of dependant #6*
Age of dependant #7*
Age of dependant #8*
Age of dependant #9*
Age of dependant #10*
Date of birth *
Day*
Month*
Year*
Borrower 1 – Employment Details
Employment status*
Name of employer*
Occupation

Income

Please outline your income. We’ve put in some of the common incomes that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more income items, click on , if you want to remove one, click on .

Income Label	Income Amount	Frequency	Annual

Income Total

Borrower 2
Borrower 2 – Personal Details
Name*
First name * Middle name Last name *
Member number*
Residential address*
Street addressAddress line 2SuburbStatePostcode
Postal address
Same as residential address
Street addressAddress line 2SuburbStatePostcode
Preferred contact number*
Number of dependants*
Age of dependant #1*
Age of dependant #2*
Age of dependant #3*
Age of dependant #4*
Age of dependant #5*
Age of dependant #6*
Age of dependant #7*
Age of dependant #8*
Age of dependant #9*
Age of dependant #10*
Date of birth *
Day*
Month*
Year*
Borrower 2 – Employment Details
Employment status*
Name of employer*
Occupation

Income

Please outline your income. We’ve put in some of the common incomes that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more income items, click on , if you want to remove one, click on .

Income Label	Income Amount	Frequency	Annual

Income Total

Credit Provided

Please provide details for both borrowers. Please outline each credit you have been provided with, such as credit cards, home mortgage or rent, car loans and personal loans. We’ve put in some of the most common credit that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more credit items, click on , if you want to remove one, click on .

Credit Provided	Credit Provider Name	Balance	Minimum Repayment	Frequency	Annual	Arrears/Advance

Credit Total

Household Expenses

Please outline your household expenses, such as electricity and gas bills, rates and internet. We’ve put in some of the most common expenses that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more household expense items, click on , if you want to remove one, click on .

Household Expense	Cost	Frequency	Annual	Arrears/Advance

Household Expenses Total
Education Expenses
Please outline your education expenses. We’ve put in some of the most common expenses that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more education expense items, click on , if you want to remove one, click on .
Education Expense Cost Frequency Annual Arrears/Advance
Education Expenses Total

Insurance Expenses

Please outline your insurance expenses. We’ve put in some of the most common expenses that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more insurance expense items, click on , if you want to remove one, click on .

Insurance Expense	Cost	Frequency	Annual	Arrears/Advance

Insurance Expenses Total

Personal & Family Expenses

Please outline your personal and family expenses. We’ve put in some of the most common expenses that people have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

If you want to add more expense items, click on , if you want to remove one, click on .

Expense	Cost	Frequency	Annual

Personal & Family Expenses Total

Assets
Please outline assets you own. We’ve put in some of the most common assets that people might have, but feel free to change them by typing over the existing label or add more based on your own personal circumstances.

Please provide as much detail as possible in the description field.

If you want to add more assets, click on , if you want to remove one, click on .
Asset Description Value
Assets Total

Consent to electronic delivery of documents
Applicant 1 – consent to electronic delivery of documents*
- Yes
- No
Applicant 2 – consent to electronic delivery of documents*
- Yes
- No
If “Yes” is selected, each Applicant consents to Police Credit Union providing documents to you by:
- sending them to you by email to the email address(es) you have provided to us; or
- making them available for you to download in internet banking and notifying you by email when they are available
The documents we may provide in this way are:
- communications and information we are required to give you;
- if we approve your application, your offer and credit contract (and you agree that we may’sign’ the contract electronically by inserting an electronic signature or simply by providing the document to you in one of the above ways, in which case it will be deemed to have been signed by us); and
- any other document relating to your credit contract, or to any other credit or deposit account you have with us, which the law allows us to provide to you in this way, including statements of account and notices.
If you provide your consent paper documents may no longer be provided to you, you must regularly check internet banking and/or emails for notification from us about documents, and you may withdraw your consent to us giving documents to you by electronic communication at any time.

Total Surplus / Deficit

Please add any notes or comments and proceed to submit the form.
Annual
Monthly
Fortnightly
Weekly
Notes or Comments
Disclaimer*
- By clicking Submit, I/we declare that the details provided in this statement are true and correct. I/we understand that providing false or misleading information could result in the cancellation of any agreements and the initiation of legal action.
Name
This field is for validation purposes and should be left unchanged.

Asset	Description	Value

Borrower 1

Borrower 1 – Personal Details

Borrower 1 – Employment Details

Borrower 2

Borrower 2 – Personal Details

Borrower 2 – Employment Details

Consent to electronic delivery of documents

Total Surplus / Deficit