| Name: * |
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| Contact Number 1: |
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| Contact Number 2: |
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| Email: * |
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| I / We are looking to; * |
| Buy a home to live in |
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| Buy a house as an investment |
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| Buy land |
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| Build a house |
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| Buy a holiday home |
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| Refinance my existing loan/s |
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| Other |
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| I / We are First Home Buyers |
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| My / Our current income (before tax) is; |
| Applicant 1 |
per
|
| Applicant 2 |
per
|
| Applicant 3 |
per
|
| Applicant 4 |
per
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| Existing rent payabale is |
per
|
| |