Debt Agreement Questions – Australian Debt Solutions

Debt Agreement required information

Complete the questions as best you can.

If on a mobile phone, hold the phone sideways to see full question. If you are not sure leave blank.

Type answers into the question box.

You will also get the final documents to check over.

Title Title Mr Mrs Miss Ms

Gender Gender Male Female Prefer not to answer

First Name

Middle Name/s

Surname

Other names used in the last ten years? Type them here

Date of Birth

Drivers Licence Number and state issued

Current Address (include State and Postocde)

How many years and moths have you lived here?

Postal Adddress (If Different)

Phone Number

Email Address

How many people depend on you for financial support

Do you have a partner? If Y their name and Gross income

Employer Name

Job Title and/or occupation

What is your pay period? What is your pay period? Weekly Fortnightly Twice Monthly Monthly

How many hours do you work (on average) per week?

What is your employment status? What is your employment status? Casual Full-time Part-time Self Employed

Employer Address

In regard to your residential address, are you In regard to your residential address, are you Buying with a mortgage Renting Boarding Own the property outright

What was your previous residential address?

What was your 2nd previous residential address?

Did you own or were buying these previous addresses?

Have you bought or sold any real estate in the last 2 years?

Have you been Bankrupt or in a Debt Agreement before?

What month and year did you start having debt troubles?