Visa Credit Card Visa Credit Card

7 Balance transfer reques t Yes, I want to transfer a balance from another credit/store card. 10 Credit Limit Privacy Statement and Consent Institution/Bank Name $ Account Name Balance to be transferred (please specify an amount) (NB: For the purposes of this Statement and Consent, “personal information” is information about an d which identifies individuals. It includes information obtained from an individual or a third party an d includes anything about credit worthiness, standing, history and capacity which, under or in accordance with the Privacy Act, 1988, may lawfully be exchanged.) I acknowledge that, except where you are required by the Financial Transaction reports Act to identify me, it is not compulso ry for me to disclose personal information to you in connection with this application but without it, you may not be able to grant my application. Subject to th e Privacy Act, 1988, I ma y, at any time, access the personal information you hold about me by writing to the Privacy Officer, (at the address shown below). I agree that I may be charged a fee for accessing my personal information depending on the ci rcumstances. At the time of my request you will advise me of any applicable fee. I agree that personal information provided to you at any time in connection with this application or product may be held and used by you to assess and process the application, establish, provide and administer the product and execute my instructions. In doing so, I agree that you may exchange personal information about me with credit reporting agencies and other financial institutions (including my credit union). If I was introduced to you through my employer or another sponsor I agree you may exchange information with the organisation that introduced me . I agree that you may use my personal information, as relevant , to; consider other applications I make; comply with legislative and regulato ry requirements; conduct market or customer satisfaction research; develop, establish and administer alliances and other arrangements; develop and identify products and services that may interest me; and (unless I ask you not to) provide me with information about other products and services . I agree that you may also exchange my personal information with; your agents, contractors an d external advisers; regulatory bodies and gov ernment agencies; my referees (including my employer); external payment systems operators; your and my insurers or prospective insurers (and underwriters); other organisations with whom you have alliances or arrangements to promote or provide our respective products and services (and their agents and contractors); an organisation proposing to fund the acquisition of or acquire any interest in any obligation I ma y owe you (and that organisation’s agents and advisers); any person to the extent necessar y, in your view, in order to carry out my instructions; and (unless I tell you not to) other organisations (including your related bodies corporate) for the marketing of their products and services . I acknowledge that, notwithstanding anything else in this statement, I ma y, at any time after my application has been approved, advise you that I do not wish to receive any direct marketing communication. I may do this by contacting my credit union on (03) 9363 2530 . $ My Existing Other Credit/Charge Card Account No. Visa Credit Card Institution/Bank BPAY Biller Code BPAY Reference No. (if not credit card account no. above) (These details usually found in the BPAY section of your credit card statement) 8 Automatic payment reques t Place X in appropriate box Yes, I wish to make monthly automatic payments to my Visa credit card as follows: Minimum Payment Set Monthly Amount (please specify) $ I authorise you to vary this amount so that it is not less than the minimum payment or greater than the outstanding balance shown on my statement My full outstanding balance shown on my statement adjusted for credits received prior to my due date Signature Please debit the account detailed below to pay my Visa credit card: From My Circle Credit Membership Account Type (e.g. S6) I confirm that the information given in this application in relation to me is true and correct and I authorise you to verify any details. I acknowledge that you will rely on this information in deciding whether to approve this application. I authorise the collection, use and disclosure of information about me in the manner set ou t under the heading ‘Privacy Statement and Consent’ above. I represent that, if at any time I supply you with personal information about another person (for example a referee), I am authorised to do so and I agree to inform that person who you are, that you will use and disclose their information and that they can gain access to the informatio n you hold about them . I authorise you for any purpose (including securit y, training or information verification) to listen to and/or record any telephone call to which I am a party with you . From Financial Institution Name Account Name BSB No. Account No. Branch Upon my acceptance of a Visa credit card, I authorise you to arrange the balance transfer requested opposite. I understand and agree that my Credit Union will endeavour to comply with the automati c payment request set out opposite. It will not accept liability through any omission or delay in doing so, it will not do so where I do not have adequate funds available to me for the payment and it may, in its discretion, determine the order of priority of payment by it of any monies to be debited pursuant to this request and any other mandate given by me to it . World Wide Access Low Monthly Fee Direct Debit Option 55 days Interest Free Internet Access Visa Security Monthly Statement *Conditions & Fees Apply 9 Additional card holder Additional Visa card I wish to apply for an additional Visa card to operate on my account for the person whose name and signature appears below. I confirm that this person is over the age of 18 years. In accordance with section 18N(1)(ga)(ii) of the Privacy Act 1988, I authorise this person to seek access from the Credit Union to any information concerning any of my account which may be operated by use of the additional Visa card. I agree to indemnify the Credit Union against any loss, damage or penalt y which it may incur arising out of the operation of this authorit y, provided that the Credit Union has acted within the terms of this authorit y. I declare that the Credit Union may act upon this authority until it has received my written instructions to the contrary . Signature of Primary Member SIGN HERE Signature of Secondary Joint Member (if applicable) Date / / Low Interest Rate* Name of Additional Cardholder Signature of Additional Cardholder SIGN HERE Date / / This credit card facility is offered by Circle Credit Co-operative Limited ABN 55 087 651 376 S55-Nov 2005 The additional cardholder’s identity must be verified before their card can be activated. When completed, please fax back on (03) 9217 8100 or return to: Circle Credit Co-operative Limited, Gate 6 Tilburn Road, Deer Park VIC 3023. Phone (03) 9363 2530. 1 Eligibility and credit limit amount Home Phone No. AREA CODE Mobile No. 4 Internet & telephone banking access I understand that to be eligible for a Circle Credit Visa credit card: - I must be a Circle Credit member - I am at least 18 years of age - I am a permanent Australian Resident - I have a good credit rating My Circle Credit Member No. is I wish to apply for a credit limit of (Between $2,000 and $15,000) E-mail Address Internet and telephone banking facilities are available on your Circle Credit membership account to access your Visa credit card account. I wish to activate the following: Previous address (If at current address less than three years) Unit/Street No. Street Name (You should refer to the Circle Account & Access Facility Product Disclosure Statement for more information on the access facility you wish to activate below) Net Link Internet Banking with BPAY® Phone Link Telephone Banking with BPAY® $ I wish to apply for the: (Please tick) Home Owners Everyday Interest Rate Standard Everyday Interest Rate Suburb/Town State Postcode Time at this Address YRS MTHS NOTE: You must supply an identification code (refer below) which we will use to confirm your identity by telephone before supplying you with an initial access code for Net Link and/or Phone Link. Please contact our office to setup external payments to other Circle Credit membership accounts or financial institutions on the Net Link facility. To apply for the Home Owners Everyday Interest Rate, proof of home ownership is required. If mortgage not held with Circle Credit, please attach copy of latest rate notice. Your identification code for the Net Link and Phone Link access facilities Place X in appropriate box Special member benefit MemberCare Loan Protection Insurance (debt dies with borrower). COMPLIMENTARY death cover is available on the outstanding debt balance up to $100,000* you have with Circle Credit Co-operative Limited. This cover is subject to the satisfactory completion of the MemberCare Loan Protection Insurance Declaration Form which will be sent to you upon approval of your application for credit. *Please check with our office for details . 3 My employment details Please choose an identification code that will not be forgotten. Primary member Full Time YRS MTHS 5 My income $ $ $ PER MONTH Please provide evidence of income with application. Please include a recent pay slip or tax return if self employed Self Employed Retired Student Not Employed MTHS Part Time My Monthly Income After Tax (Net) My Spouse’s Monthly Income After Tax (Net) My Other Monthly Income After Tax (Net) (e.g. Rent, Dividends, Second Job) Time at current employment Time at previous employment YRS PER MONTH 2 Title My personal detail s Mr Mrs Ms Miss Other Place X in appropriate box Occupation PER MONTH 6 Middle Initial Employer’s Name My finances Own Buying Renting Place X in appropriate box Boarding First Name Home ownership Assets Home Surname Employer’s Address Value of what I own $ $ $ Value of what I owe Balance Owing Monthly repayment from my income Date of Birth DAY MONTH YEAR Driver’s Licence No. If you are a self employed person, please provide the following details: Accountant’s Name Motor Vehicle(s) Other Assets such as savings, investments, property, shares etc. Marital Status Married Spouses’s Mr Title Spouses’s First Name De facto Mrs Single Ms Other Miss Other Middle Initial Accountant’s Phone No. AREA CODE Liabilities Mortgage/ Home Loan Spouse’s employment details (if applicable) Full Time YRS MTHS $ Balance Owing $ Monthly repayment from my income Part Time Self Employed Retired Student Not Employed MTHS Car Loans/ Lease Payments Personal Loans/ Investment Loans (all other loans excluding credit cards) $ Balance Owing $ Monthly repayment from my income Time at current employment Time at previous employment YRS Spouse’s Surname Occupation $ $ Monthly payment from my income Spouse’s Date of Birth DAY MONTH YEAR Spouse’s Driver’s Licence No. Employer’s Name Rent/Board I have credit cards/store cards with: $ Number of Dependent Children Ages Employer’s Address Residential address (Please no PO Boxes) Unit/Street No. Street Name Institution If you are a self employed person, please provide the following details: Accountant’s Name No. of Cards Total Limits Total Owing Suburb/Town Institution $ $ Accountant’s Phone No. State Postcode Time at this Address YRS MTHS AREA CODE No. of Cards Total Limits Total Owing $ $