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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