APPLICATION TO LEASE / ASSIGNMENT OF LEASE
Full Name: Current Residential Address: Previous Residential Address: Telephone: Business: Home: Registered Office (if a Company): ACN/ABN (if applicable): Trading Name (if applicable): Date of Birth: Place of Birth: LEASE DETAILS ( ( ) )
Shop No: Proposed Business: Proposed Assignment / Lease Commencement Date: Current Rental: Current Outgoings: Lease Term / Remaining Term: Options: Rent Reviews: Guarantors (if applicable) Full Name: Address:
LEASING / BUSINESS AGENT
Name of Company: Representative: Address: Telephone Number: Facsimile Number: ( ( ) )
Statement of Assets & Liabilities as at: Note: 1. 2.
day of
200
If Assets/Liabilities are held jointly, then only that proportion relating to the party making the Declaration is to be included. Address of any property is to be given.
LIABILITIES Owing on house to
$
ASSETS House at
$
Owing on other dwellings Owing on vacant land to Owing on Motor Vehicle to 1. 2. 3. Owing on Furniture to Overdraft with Other loans with 1. 2. 3. Other 1. 2. 3.
Other dwellings at Vacant Land at Motor Vehicles 1. 2. 3. Furniture Cheque Accounts with Savings Accounts with 1. 2. 3. Life Insurance (F/V approx A/V Shares )
CREDIT CARDS 1. 2. 3. Total Liabilities (Credit Limit) (Credit Limit) (Credit Limit) $
Other Assets (eg: boats, jewellery,etc) 1. 2. 3. Total Assets Deduct Total Liabilities Surplus Assets over Liabilities $
I / We the aforementioned hereby declare that the above statement of assets and liabilities is a true and accurate reflection of my / our current financial position.
LESSEE / ASSIGNEE
LESSEE / ASSIGNEE
DATE
DATE
RESUME OF PREVIOUS EXPERIENCE & QUALIFICATIONS
CREDIT REFERENCES
Company 1. 2. 3. ~ ~ ~
Person ~ ~ ~ ( ) ( ) ( )
Phone No.
PERSONAL REFERENCE
Person 1. 2. 3. ~ ~ ~
Relationship ~ ~ ~ ( ) ( ) ( )
Phone No.
CREDIT CHECK AUTHORITY I/We, the aforementioned, hereby give authority to Cockles Pty Ltd to conduct a check of my/our credit records through the Bay Corp Advantage Association and to make whatever other enquiries that are necessary to properly assess this application.
Lessee / Assignee
Lessee / Assignee
Date
Date