Visio-Citibank Mortgage Application Visio 2002 v22 (w Sig card)vsd

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					                                                           Mortgage Application form

      Introducer details               (Broker to complete)

     Introducer name                                    Introducer ID          Mobile                                    Fax
                                                                                                                          (       )
     Agent name                                         Representative ID      Email


                                                                               Preferred method of contact?            Fax            Email
     Application ID



      Additional comments




       Checklist for submission                      (To assist broker)



                  Fax your application to:
                     NSW / ACT: (02) 8225 5027                   VIC / SA / NT / TAS: (03) 9642 5561                    QLD: (07) 3347 4010
                     WA: 1300 651 476                                                               Please note: Original application not required.



       Please ensure the following items have been included in the submission:
       All Clients                                                             Refinance clients
                Fully completed application form                                       Six month’s loan statements for all mortgages being refinanced
                Additional copy of this form if there are more than                    Six month’s statements for ALL loans being refinanced with Self-
                two Applicants                                                         certified option (including credit cards)
                Capacity worksheet
                                                                               New purchase clients
       PAYG clients                                                                    Proof of deposit
                Current payslip (computerised or less than one month old)              New purchase contract if applicable
                OR                                                                     (front page only and fully completed)
                Current employment letter (less than one month old) on
                                                                               First Home Owner’s Grant (FHOG) clients
                company letterhead
                                                                                       FHOG application form
                OR
                                                                                       Fully executed and dated purchase contract
                Last financial year’s group certificate or tax return
                confirming continuity of income/employment                             Copy of Applicant’s birth certificate (plus marriage certificate if
                                                                                       name changed) or a copy of their passport

       Self-employed clients                                                   Investors
                Business registration certificate                                      Proof of rental income if applicable
                Last two year’s personal tax returns                                   (not required for Self-certified option)
                Last two year’s final tax/business returns for ALL trading     Hi-lend clients above 80% LVR
                entities (Company, Partnership, Trusts) including profit and
                                                                                       Current six month’s statements for ALL loans being refinanced
                loss and balance sheets.
                                                                                       (including credit cards)
                OR
                                                                                       5% proof of deposit saved by way of last six month’s savings
                Self-Certification form if the application is for a                    statements, 95% LVR
                Self-certified option (please include any PAYG income in the
                                                                                       Family/parenting allowance to be evidenced by both sides of
                Self-Certification form together with PAYG evidence as
                                                                                       Centrelink form
                described above).
                                                                                       All income and profits to be evidenced by tax returns as
       Company clients                                                                 per above.
                Company Details attachment if there is a company               Overseas clients
                Applicant                                                              Overseas Borrower – Accountant Declaration completed and
                Business registration certificate                                      signed by the client’s Accountant.



Citibank Pty Limited ABN 88 004 325 080 AFSL No. 238098
Mortgage application form version 2.2
                                                (All Applicants to complete.
      A. Personal Details                       If there are more than two Applicants, please attach an additional copy of this form)

      Applicant 1 (the primary income earner)                                                   Applicant 2
     Type of Applicant            Borrower           Guarantor, please select type             Type of Applicant            Borrower           Guarantor, please select type
                                                          Third party      Director                                                                 Third party     Director

     Are you a trustee?           No    Yes, name of trust                                     Are you a trustee?           No     Yes, name of trust


     Title             First name                                                              Title             First name


     Middle name(s)                                                                            Middle name(s)


     Surname / family name                                                                     Surname / family name


     Date of Birth                                      Gender                                 Date of Birth                                       Gender
                   /           /19                            Female             Male                        /           /19                            Female             Male
     Driver’s license No.                                                                      Driver’s license No.


     Current residential address                                                               Current residential address
     (not a P.O. Box address)                                                                  (not a P.O. Box address)                                   Same as Applicant 1




                                                               Postcode                                                                                  Postcode

     Years at this address                   Years at previous address                         Years at this address                   Years at previous address
     Phone no. (home)                           Phone no. (work)                               Phone no. (home)                           Phone no. (work)
      (        )                                 (        )                                     (        )                                 (        )

     Mobile                                     Fax                                            Mobile                                     Fax
                                                 (        )                                                                                (        )

     Email                                                                                     Email


             I consent to being informed about products, services and offers                           I consent to being informed about products, services and offers
             via email and/or sms.                                                                     via email and/or sms.

     Marital status                                                                            Marital status
          Married        Single        Divorced               Widowed            Defacto            Married        Single        Divorced               Widowed            Defacto
     No. of dependents Mother’s maiden name (if applicable)                                    No. of dependents Mother’s maiden name (if applicable)

                                                                       for security purposes                                                                     for security purposes

     Spouse’s full name (if applicable)                                                        Spouse’s full name (if applicable)



     Residential status after settlement                                                       Residential status after settlement
       Own home               Rent             Mortgage             Board                        Own home               Rent             Mortgage             Board

     Residential address after settlement                 Pre-approved loan/TBA                Residential address after settlement
     (if different to current residential address)                                             (if different to current residential address)              Same as Applicant 1




                                                               Postcode                                                                                  Postcode

     Postal address after settlement                      Pre-approved loan/TBA                Postal address after settlement
     (if different to current residential address)                                             (if different to current residential address)              Same as Applicant 1




                                                               Postcode                                                                                  Postcode

     Is your principal residence in Australia?                Yes           No                 Is your principal residence in Australia?                Yes           No
     What is your citizenship? (if not Australian)                                             What is your citizenship? (if not Australian)




Mortgage application form     version 2.2                                            Page 1 of 10
      B. Employment details                      (All Applicants to complete)
                                                (All Applicants to complete)

       Applicant 1                                                                          Applicant 2
      Are you self employed?      No                 Yes (please skip to section C)        Are you self employed?       No                 Yes (please skip to section C)
      Employment Status                                                                    Employment Status
        Full time       Part Time                    Casual           Retired                 Full time       Part Time                    Casual           Retired
        Student         Home duties                  Unemployed                               Student         Home duties                  Unemployed
     Occupation                                                                            Occupation


      Current Employer’s details                                                           Current Employer’s details
      Employer’s name                                                                      Employer’s name



      Payroll phone no.                                              Years      Months     Payroll phone no.                                               Years    Months
                                              Time with current                                                                     Time with current
       (       )                                                                            (        )
                                                     employer                                                                              employer
                                                                     Years      Months                                                                     Years    Months
    No. of employers in                      Time with previous                           No. of employers in                      Time with previous
            last 4 years                              employer                                    last 4 years                              employer

      Gross monthly salary                    Primary source of income is from             Gross monthly salary                     Primary source of income is from
      $                                               Australia            Overseas         $                                               Australia            Overseas


      C. Self-employment details                            (Self employed Applicants to complete)
                                                          (Self employed Applicants only to complete)
      Applicant 1                                                                           Applicant 2
     Trading name                                                                          Trading name


     Address                                                                               Address



                                                                Postcode                                                                              Postcode

     ABN                                                             Years      Months     ABN                                                             Years    Months
                                                Time in current                                                                       Time in current
                                                      business                                                                              business
                                                                                                                                      Business structure
      Gross monthly salary                     Business structure                          Gross monthly salary
                                                                                                                                         Sole trader             Partnership
      $                                           Sole trader              Partnership      $
                                                                                                                                            Company
                                                      Company
      Directors salary (if applicable)        Primary source of income is from             Directors salary (if applicable)         Primary source of income is from
      $                                               Australia            Overseas        $                                                Australia            Overseas

     Principal business activity                                                           Principal business activity


     Name of accountant’s firm                                                             Name of accountant’s firm


     Accountant’s name                         Accountant’s phone no.                      Accountant’s name                          Accountant’s phone no.
                                                 (          )                                                                          (          )


      D. Business income details                            (Company or Self employed Applicants to complete)

      Company net profit (last financial year)                       Superannuation                                           Depreciation (per annum)
       $                                                              $                                                        $

      Company net loss (last financial year)                         Interest                                                 Other
       $-                                                             $                                                        $



      E. Business profile details                         (To be completed for business loans only)

      Deposits                                                                   Withdrawals
      Average number of deposits per month                                       Average number of withdrawals per month

      Average value of deposits          $                                       Average value of withdrawals      $


Mortgage application form    version 2.2                                         Page 2 of 10
                                       (Borrower Applicants to complete.
      F. Loan details                  If there are more than two accounts, please attach the Loan Details attachment for Additional Split Accounts)
      Purpose of loan
           New purchase for use as a home           $                                  Other, please specify                    $

           New purchase for an investment           $

           Refinance of current loan                $                                                    Total value of loan    $


       Is this loan regulated by the Uniform Consumer Credit Code (i.e., predominantly for purposes other than investment or business)?
              Yes         No (Please ensure you complete section P)


           Products                                                                  Product options
               Basic mortgage (cannot be combined with other products)                   Mortgage Plus (Standard, Offset or Mortgage Power option 15 only)
               Standard mortgage (fixed or variable)                                  Note: For this option, leave the ‘Product Option’ field in BOLT blank.
               Mortgage Power                                                            Intro rate (Standard or Offset only)
               Offset mortgage                                                           Mortgage Power option 15
               Construction loan                                                         Mortgage Power option 30
               Business Power (commercial only)                                          Self-certified (Standard or Mortgage Power only)
                                                                                         Fixed term (Standard fixed mortgage only)


      Split account 1 (primary product)
      Product                                                                        Product option
         Basic mortgage                     Offset mortgage                             Mortgage Plus                          Intro rate
         Standard mortgage                  Construction loan                           Mortgage Power option 15               Mortgage Power option 30
         Mortgage Power                     Business Power                              Self-certified                         Fixed term, please
                                                                                                                               specify number of years

      Amount                                    Interest only yrs   Total term yrs     Name required on statement or cheque book (account styling)
       $


       DIRECT DEBIT REQUEST (Optional for Mortgage Power only)                                  (I) Account details
                                                                                            Account name(s)
       Payment frequency
          Monthly      Fortnightly
       Account to debit payments from                                                       BSB                         Account number
          New offset savings account (Offset mortgage customers only)
            An existing Citibank account - please complete (I)                                 (II) Financial institution details
            An existing account with a different institution -                              Name and Address of financial institution
            complete (I) and (II)

            Another account part of this loan - please select the account
                                                                                                                                            Postcode
                         Account 2         Account 3       Account 4
              I/We authorise and request Citibank Pty Limited (ABN 88 004 325 080) (User ID: 10412) to debit from my/our nominated account through the
                                                     Bulk Electronic Clearing System in accordance with the Direct Debit Service Agreement in Section L.


      Split account 2 (optional)
      Product                                                                        Product option
         Basic mortgage                     Offset mortgage                             Mortgage Plus                          Intro rate
         Standard mortgage                  Construction loan                           Mortgage Power option 15               Mortgage Power option 30
         Mortgage Power                     Business Power                              Self-certified                         Fixed term, please
                                                                                                                               specify number of years

      Amount                                    Interest only yrs   Total term yrs     Name required on statement or cheque book (account styling)
      $

                                                                            (I) Applicants only)
       DIRECT DEBIT REQUEST (Optional for Mortgage Power only) Power and Offset Account details
                                   (To be completed by Mortgage
                                                                        Account name(s)
       Payment frequency
          Monthly      Fortnightly
      Account to debit payments from                                                        BSB                         Account number
         New offset savings account (Offset mortgage customers only)
            An existing Citibank account - please complete (I)                                 (II) Financial institution details
            An existing account with a different institution -                              Name and Address of financial institution
            complete (I) and (II)

            Another account part of this loan - please select the account
                                                                                                                                            Postcode
                         Account 1         Account 3       Account 4

              I/We authorise and request Citibank Pty Limited (ABN 88 004 325 080) (User ID: 10412) to debit from my/our nominated account through the
                                                     Bulk Electronic Clearing System in accordance with the Direct Debit Service Agreement in Section L.


Mortgage application form     version 2.2                                    Page 3 of 10
      G. Assets and Liabilities                          (All Applicants to complete)


                                                                Monthly income                                                                Financial
       Asset / Liability      Value                                                        Amount owing                Monthly payments       institution          Refinance?
       Residence                 $                                                         $                            $

       Rental property 1
                                 $                               $                         $                            $
         unit     house
       Rental property 2
                                 $                               $                         $                            $
           unit      house

       Home contents             $                                                         $                            $

       Vacant land               $                                                         $                            $

       Motor Vehicle 1           $                                                         $                            $

       Motor Vehicle 2           $                                                         $                            $

       Superannuation            $                               $

       Savings                   $                               $

       Credit card 1
       Type
                                 $                      Limit                              $                            $
       Credit card 2
                                 $                      Limit                              $                            $
       Type

       Personal loans                                                                      $                            $

       Monthly rent                                                                                                     $

      Other asset or liability (eg, jewellery, paintings, child support, family loan)
                                 $                               $                         $                            $

      Other asset or liability
                                 $                               $                         $                            $


                      Total      $                               $                         $                            $

                                                                (To be completed for each security property. If there are more than two security properties,
      H. Security property details                              please attach the Additional Security Property Details attachment.)

      Property 1                                                                               Property 2
     Property type            House            Villa/Townhouse               Vacant land       Property type         House         Villa/Townhouse               Vacant land
                                                                       2                                                                                    2
                              Unit, area of unit (if less than 40m )                                                 Unit, area of unit (if less than 40m )

     Property usage           Owner occupied            Investment                             Property usage        Owner occupied         Investment

     Security type            Residential               Commercial             Other           Security type         Residential            Commercial              Other

     Title type               Torrens          Strata       Company            Other           Title type            Torrens       Strata       Company             Other

     Name(s) appearing on title                             Same as Applicant(s)               Name(s) appearing on title                       Same as Applicant(s)



                                      Same as                        Pre-approved loan/                                      Same as                   Pre-approved loan/
     Address of property              residential address            TBA                       Address of property           residential address       TBA


                                                                Postcode                                                                           Postcode

     Estimated market value or                 Land size (if greater                           Estimated market value or           Land size (if greater
     purchase price                            than 2 hectares)            2nd Mortgage?       purchase price                      than 2 hectares)             2nd Mortgage?
      $                                                                        Yes    No        $                                                                   Yes    No

     Contact to arrange property valuation                                                     Contact to arrange property valuation
     Full name                                                                                 Full name


     Phone no. (work)                              Mobile                                      Phone no. (work)                        Mobile
      (       )                                                                                 (       )

Mortgage application form        version 2.2                                       Page 4 of 10
                                                                                  (To be completed if a settlement agent will be used,
      I. Solicitor’s or representative’s details                                  by Borrower Applicants only)
     Name of firm               Not yet known/TBA (please skip to section J)             Address


                                                                                                                                             Postcode
     Contact’s full name                                                                 Phone no.                               DX (Document exchange no.)
                                                                                          (       )


      J. Citibank Credit card                      (To be completed by Mortgage Plus Applicants only)

      New Citibank GOLD VISA credit card only:
      By applying for a Mortgage Plus package, you are requesting Citibank to provide the Citibank Gold Visa Credit Card facility (minimum credit limit $5,000)
      and send the Citibank Visa Credit Card (including any additional card) to you. This card will be issued following receipt of your signed mortgage
      documents by Citibank.

     New or existing card?                                                               Do you require an Additional card?
           Issue a new Citibank Gold Visa credit card.                                        No, I do not require an additional card.
           Use my existing Citibank credit card as part of my Mortgage Plus                   Yes, I confirm the identity of and wish to apply for an Additional
           package.                                                                           Card for Applicant 2 as part of this application.
           Card number                Upgrade my Silver card to Gold




       K. Terms and Conditions of loan application                                     (Applicable to all Applicants)

      Age of Applicant
      1. Applicants must be 18 years or over to apply for a Citibank loan.             7. Where there are more than 2 Applicants, further application form(s)
                                                                                          m ust be com pleted . Info rma tion provided in all completed
      Information Correct                                                                 application forms will be treated as one application.
      2. Each Applicant confirms that all of the information set out in this
          application is, to the best of their knowledge, true and correct.            Fees
          Citibank may cancel any approval given if any information is found           8. If this application is approved, the Borrower Applicant(s) will be
          to be misleading or incorrect.                                                  required to pay all costs and expenses incurred by Citibank in
                                                                                          progressing the application to final approval or settlement
      3.   The Applicant(s) authorise Citibank to check all information in this           (including stamp duty, valuation and legal fees), whether or not the
           application. The Applicant(s) will provide Citibank with any details           advance is made.
           of the Applicant(s)’ income that Citibank may request. The
           Applicant(s) will ensure that the property valuer nominated by              Important Notice
           Citibank is provided with full access to the proposed security              9. Neither Citibank, nor any of its staff, is in a position to advise on the
           property.                                                                      suitability of any investment being funded by the proceeds of any
                                                                                          mortgage loan, nor is any other person authorised to give such
     Interest Rates                                                                       advice on its behalf. The Applicant(s) should consider taking advice
     4. The annual percentage rate quoted is that prevailing at the date of               from an independent qualified adviser.
         this application. With the exception of the Citibank's fixed rate
         products, the interest rate for Citibank variable rate mortgages are
         reviewed each month or 3 months as applicable and may change.                 Offset Mortgage
         Rates for fixed rate mortgages referred to in any approval will be            10. If you are applying for an Offset mortgage, you should consider the
         held for 60 days from the date of application and may change                      P rodu ct Di sc lo su re Sta tem en t whi ch is a va ila ble at
         after this.                                                                       www.citibank.com.au or by calling 13 2484 or from your mortgage
                                                                                           broker.
     Tax File Numbers
     5. Prior to providing Citibank with any documentation, we suggest
        Applicant(s) delete or remove any tax file number referred to in that          Credit Card (Mortgage Plus Applicants)
        documentation.                                                                 11. If you are applying for a credit card account, the Primary
                                                                                          Cardholder (Applicant 1) is responsible for all debts incurred by all
     No Legal Commitments                                                                 additional Cardholders. The Additional Card may be cancelled at
     6. This is an application only and no legal commitments should be                    any time by phoning Citibank. The cancellation may not be effective
        entered into before receipt of a full, written approval from Citibank.            until the Additional Card is surrendered or the Primary Cardholder
        Any approval given will be subject to conditions to be outlined in a              has taken all reasonable steps to have the Additional Card returned
        detailed Approval of Finance.                                                     to Citibank.


      L. Direct Debit Service Agreement                            (Applicable to Borrower Applicants only)

     I /We understand, acknowledge and agree that:                                     3. You authorise Citibank to debit your repayments and/or any other
                                                                                          charges due to Citibank under your credit contract with Citibank.
     1. These terms and conditions constitute the Direct Debit Request
        Service Agreement.                                                             4. If you have elected fo rtnightly repayments , the fortnightly
                                                                                          repayments will be one half of the amount of the monthly repayment
     2. Citibank Pty Limited (ABN 88 004 325 060) (“Citibank”) will initiate              rounded up to two decimal places (ie where this resulting amount
        debits from your nominated bank account in accordance with                        has more than 2 decimal places the nearest 2nd decimal place is
        Section H – Loan details.                                                         increased by $0.01). (Only applicable for

                                                                                                                                             Signed
      Office use only       Gross verified
                                           $                   Dependents                                 FTRA obtained     Bureau checked
                                  annual                          (inc self)
                                                                                                          Additional card
      Source code:                                                                                                                           Date
      207 GZMY5ZZA                  MDI $                        Credit limit $                       No. cards &
                                                                                                                                                      /   /
                                                                                                            types

Mortgage application form    version 2.2                                   Page 5 of 10
      L. Direct Debit Service Agreement continued ...
           “principal and interest repayment – variable interest rate facility”).               Citibank will endeavour to resolve disputes with your bank or
                                                                                             financial institution within Industry agreed timeframes.
      5. Where a payment is due on a day that is not a business day,
         Citibank may process the payment in accordance with your credit                11. In the event that the financial institution at which your nominated
         contract with Citibank.                                                            ac count is he ld, refuses to pa y an y de bit mad e und er the
      6.   Citibank agrees to provide you with not less than 14 days’ prior                 arrangement, Citibank will write to you requesting alternative
           notice if it proposes to vary the any term of this agreement.                    payment arrangements.

      7.   You may request to defer or alter the agreed arrangements by                 12. Citibank will keep all information pertaining to your nominated
           writing to Citibank Pty Limited, GPO Box 40, Sydney NSW 2001.                    account at the financial institution private and confidential.
                                                                                            However, information can be provided to Citibank or your financial
      8. You can stop individual debits or cancel a Direct Debit Request by                 institution to resolve a dispute on your behalf.
         writing to Citibank Pty Limited, GPO Box 40, Sydney NSW 2001.
                                                                                        13. Direct debiting may not be available on the full range of customer
      9.   In the event that you should disagree with any debit under the                   accounts. You should check directly with your financial institution
           arrangement with Citibank you should call Citibank on 13 24 84,                  before submitting a Direct Debit Request form to Citibank.
           or write directly to Citibank Pty Limited, GPO Box 40, Sydney
           NSW 2001.                                                                    14. It is your responsibility to have sufficient cleared funds available in
                                                                                            the nominated account by the due date to permit debiting to occur.
      10. Citibank will assist you in the event of a dispute concerning any
          debit item drawn on the nominated account in compliance with the              15. Citibank may cancel a Direct Debit Request without notice should
          Industry’s Direct Debit Claims Process.                                           two or more payments be dishonoured.




      M. Privacy               (Applicable to all Applicants)

      The Privacy Act 1988 (Cth) regulates the way Citibank Pty Limited ABN             Get Credit Information
      88 004 325 080 AFSL 238098 (hereinafter called “Citibank”) uses
      personal and credit information about you.                                        To enable Citibank to assess an application for commercial or personal
                                                                                        credit/ assess whether to accept me/us as guarantor/s for an application
      PART 1 - PERSONAL INFORMATION GENERALLY                                           for commercial or personal credit, Citibank is authorised to get the
      Collection and Use of Personal Information                                        following information about me/us from a credit reporting agency or
      1. I/We acknowledge that Citibank collects personal information to                other business or source that provides information about credit
          assess this application and, if it is successful, to administer the           worthiness:
          product/s I/we obtain. If any part of the information is not provided
                                                                                           Personal credit information
          or is incorrect or incomplete, Citibank may not be able to assess my/
          our application or I/we may not be able to obtain from Citibank the              Commercial credit information
          products or services I/we are seeking and Citibank may not be able
          to properly administer those products or services.                               A credit report provided by aacredit reporting agency used to report
                                                                                            A credit report provided by credit reporting agency used to report
                                                                                           on overdue repayments from me/us.
                                                                                        on overdue repayments from me/us.
      2. I/We acknowledge that for you to do that, Citibank may need to
         disclose my/our personal information to Citibank’s affiliates, sales           Exchange credit Information
         agents and brokers, organisations that carry out functions on my/our
                                                                                        Citibank is authorised to give to and to get from the following parties
         behalf (such as mailing houses, data processors, researchers,
                                                                                        personal or commercial information about my/our credit worthiness,
         collection agents and loss recovery agents), professional and
                                                                                        credit standing, credit history or credit capacity:
         fina ncial adv isors, org anisatio ns involv ed in securitisa ti on
         arrangements, investigators, insurers (including, where applicable,               Another credit provider, in particular Citibank may get or give aa
                                                                                            Another credit provider, in particular Citibank may get or give
         mortgage insurers and insurers of consumer credit insurance) and                  bankers opinion about my/our business, trade or profession
                                                                                        bankers opinion about my/our business, trade or profession
         organisations involved in rewards programs.
                                                                                           Any broker, financial consultant, lawyer or other adviser acting in
                                                                                            Any broker, financial consultant, lawyer or other adviser acting in
      3. I/We acknowledge that Citibank may also disclose my/our personal                  connection with any financing provided proposed to be provided to
                                                                                        connection with any financing provided or or proposed to be provided
           information to organisations that carry out functions on Citibank’s             to
                                                                                        me/usme/us
           behalf for the purpose of the Privacy Preference (unless I/we have
           indicated that I/we do not with Citibank to communicate such offers).            A credit reporting agency or other business or source that provides
                                                                                             A credit reporting agency or other business or source that provides
                                                                                            information about credit worthiness. (Information that provided
                                                                                        information about credit worthiness. (Information that may be may be
      4. I/We ackn owledge th at Citib ank may be required by Financial                     Citibank by Citibank includes identity the fact that fact has been
                                                                                        by provided includes identity particulars,particulars, thecreditthat credit
          Transaction Reports Act to collect certain information about my/our               has for and the amount; the amount; the fact is credit provider; the
                                                                                        applied been applied for and the fact that Citibank that Citibank is credit
          identity.                                                                           that I/we have offered I/we as guarantor to act as guarantor an
                                                                                        factprovider; the fact that to act have offeredin respect of a loan or in
      5.   I/We acknowledge that if Citibank discloses personal information to its
                                                                                            respect of a laon or an application for a the to that another
                                                                                        application for a loan to or by another person; laon factor bypayments
           affiliates and other entities that provide services to me/us on Citibank’s        overdue more that payments are overdue action has commenced;
                                                                                        areperson; the factthan 60 days and collection more than 60 days and
           behalf, as part of that, my/our personal information may be transferred          collection action has commenced; advice that payments are no
                                                                                        advice that payments are no longer overdue; advice that cheques
           outside Australia.                                                               longer overdue; $100 that cheques drawn by me/us for $100 or
                                                                                        drawn by me/us for advice or more have been dishonoured more than
                                                                                            m r e h a v circumstances, that e m o r e t a n o n e ; s p e c i f i c
                                                                                        once;ospecific e b e e n d i s h o n o u rindCitibank’shopinioncserious credit
      6. I/We acknowledge that in most cases, I/we can access to my/our                     circumstances, that in Citibank’s opinion that credit provided to me/
                                                                                        infringement has been committed by me/us;serious credit infringement
         personal information by contacting Citibank on 13 24 84. I/We                                  committed by me/us; discharged discharged discharged
                                                                                        us has been dischargeddischarged that credit provided to me/us has
         acknowledge that charges may apply for this access.                                been discharged).
                                                                                        discharged discharged).
      7.   I/We acknowledge that my/our telephone calls and conversations with             Any insurer of consumer credit insurance (including MetLife
                                                                                            Any insurer of consumer credit insurance (including MetLife
           a Citibank representative may be monitored and/or recorded for                  Insurance Limited 75 004 004 274 882) for the of arranging
                                                                                        Insurance Limited ABN ABN 75274 882) for the purpose purpose of
           quality, training and verification purposes.                                    arranging and consumer credit insurance.
                                                                                        and administeringadministering consumer credit insurance.
                                                                                        Provide credit Information
                                                                                        Citibank is authorised to give credit information to:
      PART 2 – CREDIT INFORMATION
      Credit Facilities                                                                     A trade insurer for any purpose relating to an application for
      Credit facilities means the loan and/or credit facilities you have applied        commercial credit
                                                                                            A trade insurer for any purpose relating to an application for
      for within this application. The Applicant(s) and any Guarantor(s)                    commercial credit
                                                                                            Any person who proposes to guarantee or has guaranteed
      authorizes Citibank and any other financer which at the time provides or
                                                                                            Any person who proposes to guarantee or has me/us
                                                                                        repayment of any personal or commercial credit provided toguaranteed
      has any interest in the credit being contemplated by my/our application
                                                                                            repayment of any personal or commercial credit provided to me/us
      to do any of the following:

Mortgage application form     version 2.2                                     Page 6 of 10
      M. Privacy continued...
        Any person in connection with funding financial accommodation by
         Any person in connection with funding financial accommodation by           I/We authorise Citibank to give to any Guarantor or proposed Guarantor
        means fo an arrangement involving securitisation
      means fo an arrangement involving securitisation                              of my credit contract or other facility to which the guarantee or security
                                                                                    extends (‘Facility’), any information (including credit information) or
         Any person who is a signatory to any credit facility account provided
          Any person who is a signatory to any credit facility account provided     record that has any bearing on my/our creditworthiness, credit standing,
         to me/us and Additional Cardholders
      to me/us and anyany Additional Cardholders                                    history or credit capacity in connection with the Facility, including
         GE Mortgage Insurance Company Pty Ltd ABN 60 106 974 305                   (without limitation) copies of:

      PMI Mortgage Insurance Limited 70 000 511 071 for the purposes of                The contract for the Facility
                                                                                       The contract for the Facility
      assessing whether to insure, or the risk of providing insurance to,              The final letter of offer relating to the Facility, including details of
                                                                                      The final letter of offer relating to the Facility, including details of
      Citibank and assessing the risk of me/us or any security provider               conditions set out any earlier version of that letter               may
                                                                                    conditions set out in in any earlier versionof that letter which I/we may
      defaulting on my/our obligations to Citibank, as well as any variation or     have already met;
                                                                                      have already met;
      claim under the insurance policy and other risk, internal management
      and compliance purposes.                                                         Any related credit report from a credit reporting agency;
                                                                                       Any related credit report from a credit reporting agency;
      In this respect, these organisations may disclose my/our credit                    Any financial accounts or statements of financial position given to
                                                                                       Any financial accounts or statements of financial position given to
      information to their related companies, service providers and advisers,          you by me/us within the previous 2 years purpose of the Facility;
                                                                                    you by me/us within the previous 2 years for the for the purpose of the
      credit reporting agencies, reinsurers and government and regulatory              Facility;
      bodies. If my/our credit information is not provided by Citibank to these         The latest statement of account for the Facility;
      organisations, I/We acknowledge that Citibank may not be in a position           The latest statement of account for the Facility;
                                                                                        Any notice of demand given by you to me/us in relation to the Facility
      to provide the products or services requested.                                   Any notice of demand with by you to me/us in relation to the Facility
                                                                                    within the last 2 years given which I/we have not complied to your
      Other Disclosure                                                              satisfaction. last 2 years with which I/we have not complied to your
                                                                                       within the
                                                                                       satisfaction.
      Citibank is authorised to disclose credit information within and outside of   I/We also authorise Citibank to provide to the Guarantor:
      Australia to related companies and selected third parties for service              Any other information regarding the Facility (as well as any facility to
      such as:                                                                         Any other information regarding the Facility (as well as any facility to
                                                                                    be refinanced by the Facility) that the Guarantor may reasonably
          Selected mailhouses for statement production and other mail
         Selected mailhouses for statement production and other mail                   be refinanced by the Facility) that the Guarantor may reasonably
                                                                                    require; and
      services
         services                                                                      require; and
                                                                                         Advice as to whether the Facility will be cancelled if the Guarantee is
         Valuers for property valuation                                                Advice as
                                                                                    not provided.to whether the Facility will be cancelled if the Guarantee is
                                                                                       not provided.
         Plastic card services for card embossing                                   (If you are solely a guarantor, we will use your personal information only
                                                                                    in connection with our proposed guarantee. This may include
         Cle ri al, l ega nd s ettle me t ervice s fo d ata entry nd
        Cleric cal ,legal laandsettle men nts se rv ic esfor rdata entry aand       communicating your personal information to mortgage insurers, who
      administration, mortgage and loan documentation and settlement
        administration, mortgage and loan documentation and settlement              may use and disclose personal information in accordance with the
                                                                                    National Privacy Principles for their own purposes, which may include
         Market research for product development and planning                       disclosure to credit reporting agencies, service providers and
         Data processing and modelling services for loyalty scheme
        Data processing and modelling services for loyalty scheme                   reinsurers. They will not, however, use your personal information for
      administration and riskrisk assessment
        administration and assessment                                               marketing purposes. We will not share your information with other
                                                                                    members of the Citigroup, nor will we use if for marketing purposes).
          Professional advisors and broker and financial planning services for
         Professional advisors and broker and financial planning services for
      ac co unt adadministration offi financial p lan ning a nd commissionn
         account min istrat ion of nanc ial planning and c omm is sio               Verification
      administration
         administration                                                             I/We authorise Citibank to verify the personal and credit information in
         Collection agents for the purposes of debt collection                      this application with any Accountant/employee/referee named by me/us.

         Other organisations wishing to acquire an interest ininany part of
          Other organisations wishing to acquire an interest     any part of        I/we acknowledge that any of these authorities and consents remain in
      Citibank’s business for assessment ofof any proposed acquisition
         Citibank’s business for assessment any proposed acquisition.               force until the product/s or facility/ies to which they relate is/are at an
      acquisition.                                                                  end.

      Use of credit information                                                     You agree to this Privacy Acknowledgement and Consent by signing
                                                                                    this loan application at Section N of this form.
      It is acknowledged that credit information obtained by Citibank on me/us
      may be used for the following purposes:
          To assess an application for credit
          To assess an Applicant or Guarantor
          To assist in avoiding any defaults under any credit obligations
                                                                                       Privacy Preference: We may keep you informed about other
          To tell other credit providers about defaults made by me/us                  products, services and special offers from us and our affiliates and
                                                                                       pa rtne rs, v en dors an d ot her p arti es with wh om we ha ve
          To access my/our credit worthiness
                                                                                       arrangements that may be of interest to you. We may also disclose
          To obtain lender’s mortgage insurance                                        your personal information to our affiliates so that they can keep
                                                                                       you informed about other products, services and special offers.
      Where I/we have applied for a credit card facility (this clause applies to       However, if you do not wish us or our affiliates to communicate
      the Primary Applicant/cardholder only)                                           these offers (apart from offers in relation to substitute Citibank
                                                                                       credit products), please indicate below. Alternatively, you can
      I (the Primary Applicant) acknowledge that I will be automatically
                                                                                       notify Citibank in writing or by telephone.
      enrolled in the free Citibank Rewards Programme and that Citibank may
      for the purpose of the Rewards Programme, disclose my personal and               Our affiliates are the family of companies that form Citigroup
      transaction information to such persons or entities conducting the               Australia. These affiliates operate in several different lines of
      Rewards Programme for the purpose of conducting the programme;                   business including banking, credit cards, consumer finance,
      and to Qantas Airways Limited for the purpose of awarding Qantas                 securities, and insurance. Our affiliates conduct business under
      Frequent Flyer points.                                                           names that include Citibank, Citicorp, Diners Club, Smith Barney,
                                                                                       Citigroup Asset Management, and Citigroup Global Markets.
      Where there is/are Guarantors (‘Guarantor’ includes any person other
      than the borrower who provides, directly or indirectly, property as
      security for the borrower’s credit contract and other facilities)                                      Do not mail         Do not phone




Mortgage application form   version 2.2                                     Page 7 of 10
      N. Applicant signatures                    (ALL Applicants to complete)


        I/We the Applicant(s) agree to these Terms and Conditions any other acknowledgements and consent including my/our privacy consent made in
        this application and not separately signed.

        All sections of this form are applicable to Borrower Applicants.

        The only sections of this application form which are applicable to Guarantor Applicants are:
                      A. Personal details                  H. Security property details
                      B. Employment details                K. Terms and Conditions of loan application
                      C. Self-employment details           M. Privacy
                      D. Business income details           N. Applicant signatures
                      G. Assets and liabilities

       Applicant 1’s signature                                                     Applicant 2’s signature


        X                                                                           X
       Date                                                                        Date
                  /        /                                                                /       /




                                                                Please complete where ALL Borrower Applicants reside at same address –
      O. Address for notices schedule                           GUARANTOR APPLICANTS DO NOT SIGN

      Note – this section is to be completed where all borrower/mortgagor Applicants reside at the same address and the lending facility is to be used for
      personal purposes, ie NOT for business or investment purposes.

      Each debtor/mortgagor is entitled to receive a copy of any notice or other document under the Consumer Credit Code
      and by signing this form, you are giving up the right to both be provided with information direct from Citibank. Any
      one of you who has signed the form can advise Citibank at any time in writing that you wish to cancel your
      nomination. You will accordingly both receive a copy of any notice or other document under the Consumer Credit
      Code direct from Citibank.
                           Full name of nominated person

      I/We nominate                                                                                           to receive notices and other documents
      under the Consumer Credit Code on behalf of me/all of us. The notices and documents are to be sent to the following mailing address
      Address                                                                   Suburb                                    State                Postcode




     Borrower Applicant 1’s signature                                                Borrower Applicant 2’s signature


      X                                                                               X
     Date                                                                            Date
              /        /                                                                        /       /



      P. Declaration of purposes                      (To be completed for investment or business applications, by Borrower Applicants only)

      I/We declare that the credit to be provided to me/us by the credit provider is to be applied wholly or predominantly for business or investment
      purposes (or for both purposes).

                                                                          IMPORTANT
      You should NOT sign this declaration unless this loan is wholly or predominantly for business or investment purposes.
      By signing this declaration, you may lose your protection under the Consumer Credit Code.

     Borrower Applicant 1’s signature                                               Borrower Applicant 2’s signature


      X                                                                              X
     Date                                                                           Date
              /        /                                                                        /       /



Mortgage application form      version 2.2                                 Page 8 of 10
      Q. Citibank 100 Point Check                              (Citibank representative to complete for all Applicants)

      Financial Transaction Reports Act 1988
      Privacy Act                                                                           aware of the identity of Citibank and how to contact it, the fact that the
                                                                                            Applicant(s) is/are able to gain access to the information, the purposes
      Citibank is subject to the National Privacy Principles under the Privacy
                                                                                            for which the information is collected, the organisations or types of
      Act. The information is necessary for the confirmation of the identification
                                                                                            organisations to which Citibank usually discloses information of this
      of the Applicant(s) and other related functions or activities. Citibank has
                                                                                            kind, and the main consequences if any for the Applicant(s) if all or part
      taken reasonable steps in the circumstances to ensure that, at or before
                                                                                            of the information is not provided.
      the information is collected or, if that is not practicable, as soon as
      practicable after the information is collected from the Applicant(s), the          Existing Customers, if you have been a Deposit Account customer for
      Applicant(s) is/are generally                                                      more than 3 years or have previously been identified you do not need to
                                                                                         complete this section.

      Type of check                                                                                                       Available                Points scored
                                                                                                                           points             Applicant 1    Applicant 2
       1. Primary documents
          Passport, birth certificate or citizenship certificate                                                             70
          Only one of these documents can be used for each Applicant.
       2. Photo or Signature ID that verifies the NAME of the Applicant.
          Australian driver’s licence, pension card, current licence issued under a Commonwealth, State or
          Territory law or an ID Card issued by an Australian educational institution.                                       40
          If more than one of these documents is used, each additional document is worth 25 points only.
       3.
            Document that verifies the NAME and ADDRESS.
            From an employer within the last 2 years, rate notice, a rating authority relating to land ownership.            35
            Full name required on document.

      4. Other documents that verify the NAME and ADDRESS.
         Motor vehicle registration, electoral roll record, public utility record, document from another financial       25
         institution of which the application is a customer, marriage certificate (maiden name only), telephone
         account, foreign drivers licence, etc.
         Other documents that verify the NAME .
         Medicare card, credit card(s), etc.                                                                     Total points
         Only one document from each source may be counted                                                  Identification check results minimum 100 points.
       Documents
      Applicant                          Applicant 1          Applicant 2            Applicant 1         Applicant 2              Applicant 1             Applicant 2

      Type of document

      Document number
      Full name appearing on
      document
      Address on document
      (if shown)


      Date of birth                         /       /                                   /         /                                   /            /
      Place of issue/Issuing
      institution
      Date of issue                         /       /                                   /         /                                   /            /

      Date of expiry                        /       /                                   /         /                                   /            /


      Applicant                          Applicant 1          Applicant 2            Applicant 1         Applicant 2              Applicant 1             Applicant 2

      Type of document

      Document number
      Full name appearing on
      document
      Address on document
      (if shown)


      Date of birth                         /      /                                    /         /                                   /            /
      Place of issue/Issuing
      institution
      Date of issue                         /      /                                    /         /                                   /            /

      Date of expiry                        /      /                                    /         /                                   /            /

      Results of Check
     Has verification been achieved?                    Yes           No                                        Date         /            /

     Signature of Citibank representative
                                                 X                                                        Print name

Mortgage application form     version 2.2                                     Page 9 of 10
      R. Authority to operate mortgage account

      Terms and conditions

      I/We authorise and direct that the account below (the Account) be           Authority
      operated in the following manner:                                           Each Accountholder is separately authorised to operate the Account in
                                                                                  all respects as permitted by the Terms and Conditions applying to the
                                                                                  the Account. Without limiting this authorisation, each Accountholder is
      Duration of Authority                                                       separately authorised:
      This Authority commences immediately and revokes any previous               1. to endorse all cheques, bills of exchange or drafts payable to all or
      authorities on the Account. This Authority shall continue until Citibank    any of them individually or collectively and those which are payable to
      receives written notice from one or more of the Accountholders              less than all of them may be credited to the Account by any one or
      revoking this Authority.                                                    more without enquiry by Citibank; and
                                                                                  2. to give receipts for shipping documents and the like, and to sign
      Disputes                                                                    requisitions for letters of credit.
      Upon Citibank becoming aware of a dispute between any of the
      Accountholders or any parties Citibank considers to be relevant             Survivorship (if applicable)
      parties which may in any way affect the Account and or where the            Upon the death of Accountholder, the title to any monies held in the
      Account has been or is to be operated in a manner inconsistent with         Account shall be vested in the surviving Accountholder(s) (unless
      this Authority, Citibank may (at its own discretion) suspend the            specified otherwise).
      operation of the Account. Operation of the Account will recommence
      upon Citibank receiving written instruction from all Accountholders/        Signed by Accountholder(s)
      relevant parties to lift the suspension.                                    Before signing this Authority, please ensure that all alterations have
                                                                                  been initialled and blank spaces ruled through with a diagonal line.
      Liability                                                                   Where the Accountholder is a Company, Society or Association and
      The Accountholder(s) shall be solely responsible to Citibank (on a joint    this Authority is signed by one of more officers of that Company,
      and several basis where a joint account) for all liability incurred on or   Society or Association, then such persons warrant that they are duly
      in respect of the Account, including any liability which arises from        authorised by the Accountholders to sign this Authority on its behalf.
      Citibank in accordance with this Authority.




      Signature card


               This form must be signed by all Accountholders for settlement to proceed.




                                                                                                                                     Applicant 1
                                                                                                                                     to sign here.

                                                                                                                                     Applicant 2
                                                                                                                                      to sign here
                                                                                                                                     (if applicable).

                                                                                                                                     Applicant 3
                                                                                                                                      to sign here
                                                                                                                                     (if applicable).



Mortgage application form   version 2.2

				
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