Referral Application Form

Personal Details

First Name *

Middle Name

Last Name *

Date of Birth *

Email Address *

Phone *

Marital Status

Dependants

Accommodation Status *

Current Address *

Time at Address *

Previous Address if Less than 3 Years Ago

Loan Details

Loan Purpose *

Loan Amount *

Employment Details

Income Source *

Occupation *

Employer/Business Name *

Type of Business

Income & Expenses (per month)

Employment Income *

Rental Income

Additional Income

Total Mortgage Balance

Repayments

Rent/Board

Total Personal Loans

Repayments

Living Costs

Total Credit Card Limits

Total Credit Card Balance

Child Support Payments

Vehicle Loan Repayments

Hire Purchase Payments

Additional Expenses

Assets

Cash

Total Value of Properties

Total Value of Investments

Total Value of Businesses

Total Value of Other Assets

Supporting Documents

Declarations *

When you apply for a Loan with Luminate Finance Limited there are specific conditions that you need to agree to for us to process your application.

I/we certify all information provided is true and complete, and understand that false or misleading details may result in the application being declined and lead to criminal penalties under the Crimes Act 1961 or related laws.I/we authorise Luminate to disclose my/our relevant personal information (including defaults) with credit reporting agencies, which may update their databases and share this information with their customers.I/we acknowledge that Luminate may verify the information provided and request supporting evidence.I/We have the right to access and correct this information subject to the provisions of the Privacy Act 1993.I/we understand that Luminate Finance Limited will securely hold my/our personal information and may use it for the purposes of this application.Luminate Finance Limited may disclose information about me/us to its related companies, agents or contractors for the above purposes.

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