HTML Preview Vehicle Lease Application page number 1.
F0519 (03/14)
ORIX handles personal information according to its APP Privacy Policy that is consistent with the Australian Privacy Principles.
Please let us know if you would like a copy. It is also available at www.orix.com.au
Novated Vehicle Lease Application
Existing Customer
New Customer
Personal Details
Surname (In full):
Christian Names (All):
Current residential address:
State
Postcode
Time at current address
years
Previous residential address
(if less than 5 years at current
address)
State
Postcode
Time at current address
years
Date of Birth
Drivers licence number
Dependant Children
Home Phone
Mobile
Business Phone
Personal Email Address
Employment History
Employer
Position Held
Time with Employer
Current
years
Previous
years
Lease Details
Description of vehicle
New
Used
Private Sale
Vehicle Price
$
Term
Financial Details
Liabilities
Assets
Mortgages
$
Savings
$
Bank overdrafts (Total overdraft limit)
$
Real estate (market value)
$
Credit cards (Total of all credit card limits)
$
Motor vehicles
$
Personal debts (Personal and other loans)
$
Furniture and effects
$
Other debts
$
Other investments (excluding superannuation)
$
Total Liabilities
$
Total Assets
$
Less Total Liabilities
$
Surplus/Deficit
$
Monthly Expenses
Monthly Income
Estimated living expenses
$
Net monthly salary
$
Home mortgage repayment/s
$
Monthly car allowance
$
Car repayment/s
$
Other income
$
Other debt repayments
$
$
Credit cards
$
Total Monthly Income
$
Other
$
Less Total Monthly Expenses
$
Total Monthly Expenses
$
Surplus/Deficit
$
Declaration
I hereby declare that the information provided by me in this application is true and correct.
Signature
Date
Important: please complete and sign the Privacy Act – Disclosure Statement and Consent.