BLIND WELFARE ASSOCIATION - Beyond Blindness
Special Purpose Welfare Fund
Application for Personal Loan v1.2
Name:
Address:
Post Code: __________ Tel Number:
Mobile Phone Number:
I wish to apply for an interest free personal loan.
Purpose of the loan:
Loan amount requested (up to $2,000.00) $
Personal reference (contact name & phone no of friend or relative not living with you that we may contact for reference)
Name:
Address:
Phone no:________________ mobile no:
Relationship to you:
Financial Assessment
Income Source Monthly Nett Amount
Salary or wages (self) $___________
Pension (self) $___________
Salary or wages (partner) $___________
Pension (partner) $___________
Other income (identify type) $___________
Other income (identify type) $___________
Other income (identify type) $___________
Total Monthly Regular Income $___________
Notes:
Income sources including Centrelink income statement or bank statement to be sighted by BWA staff member
where necessary.
Expenses
Mortgage/ Rent Monthly Payment $______
Bank Loan(s) Amount Owed $______ Monthly Payment $______
Other Loan(s) Amount Owed $______ Monthly Payment $____
Credit Card Account/s
Amount Owed $_____ Monthly Payment $______
Amount Owed $_____ Monthly Payment $______
Store Account/s – White Goods, Computers, Furniture
Amount Owed $____ Monthly Payment $______
Utilities – Electricity / Gas Monthly Payment $______
Telephone, Internet Monthly Payment $______
Foxtel / Netflix Monthly Payment $______
General Living Costs (food, clothes) Monthly Payment $______
Entertainment (cigarettes, outings) Monthly Payment $______
School Fees, Uniforms Monthly Payment $______
Other (medical / chemist) Monthly Payment $______
BWA Loan Repayment Monthly Payment $______
Total Monthly Expenses Total = $______
Total Monthly Income Total = $______
Surplus/Deficit Monthly Amount Total = $______
Surplus/Deficit Fortnightly / Weekly Amount Total = $______
Copies of all expense sources (where relevant) including utilities bills are required prior to approval being granted.
Terms and Conditions of Personal Loan
• I have supplied the financial assessment required by BWA indicating my ability to repay the loan.
• I agree to repay the loan within the required period as per the attached schedule.
• I understand that if I default on this undertaking that BWA will suspend my access to other SPWF benefits until such time as the loan plus any fees incurred to Blind Welfare are repaid in full.
• I also understand that if I default on the terms of this loan I will not be eligible for SPWF benefits including the interest free personal loan for the period of 12 months once the loan including any applicable fees and charges have been repaid in full.
• I agree to authorise my financial institution to transfer regular payments (minimum monthly payments) from my account to BWA for the purpose of repayments of this loan. I will provide BWA documentation to verify that I have set up for regular payments to be transferred electronically from my account to BWA. I understand that no monies will be released to me until such documentation has been supplied.
• I give permission to BWA to obtain my location details from other blindness organisations should I default or move address without notifying BWA.
• I agree not to cancel, suspend, alter or defer any transfer request for the term of the loan without the written consent of BWA.
Bank Details and Loan Approval
Should you want your loan amount paid into your bank account, please provide the following details.
Name of Account:
Name of Financial Institution:
BSB Account Number:
Number of Installments: Amount per Installment:
Loan Amount:
Signature: ……………………… Date:
Witness: ……………………...… Date:
Form completed by:
OFFICE USE ONLY
Loan Approved: Yes No
Manager Signature:
Manager Name:
Date: ......../……../……..
Comments:
................
................
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