Fields on page 3
No
Yes
Your Customer Reference
Reference Number
Number
CRN.3
Your family name
First given name
Second given name
Your date of birth
How many properties in Australia and/or you (and/or your partner) own or have an
Address of the property
Address of the property
Q6.PropertyAddress3
Q6.PropertyAddress4
Postcode
Country (if not in Australia)
Vacant land
Bush block
Home office/business
House
Self contained flat (part of or
Units/flats/town house
Retail premises
Commercial premises
Industrial premises
Farm (or hobby farm)
Market garden
Residential block larger than
Other
Give details below
Other
Fields on page 4
If the property is made up of more than 1 title, provide details for each separate title.
$
$
$
Your share
Partner’s share
No
Do you
Yes
No
you (and/or your partner) home property only for
Yes
$
No
other
Yes
$
No
Is the
Yes
$
No
Does the
Yes
$
Provide the legal description and area of the title on which the home sits.
Fields on page 5
No
•
Yes
No
the property been your home
Yes
Do not currently make any use
Primary production
Rural residential only
Leased
Other commercial or business use
Hobby farm
Other
Give details
Other
No
Yes
themselves
Yes themselves
No
Yes
Describe the potential commercial use
Yes
No
using the
Yes
Rural residential block
Land is not viable for commercial or
Caring responsibilities
Health reasons
Zoning restrictions
Environmental restrictions
Other
Environmental restrictions
Other
No
Yes
Who owns the property
You
Percentage owned
Your partner
Percentage owned
Other
Name of person/entity
Percentage owned
Fields on page 6
Purchased
Purchase price
$
Inherited/Gifted
Other
Other
When did this property come into your ownership (the date of settlement)
Area in hectares
Area in acres
Area in square metres
Dimensions
X
What is the approximate floor area How old is in square metres
How old is the building
Exterior (for example, brick, timber)
Interior (for example, plaster, not lined)
Roof (for example, metal, tiles)
General condition (for example, fair, good, poor)
good, poor)
Q32.NoBedrooms
of
No
Is the
Yes
No
Yes
Give details below
Address of the other property used to secure the loan.
Address of the other property used to secure the loan.
Q34 Details.PropertyAddress3
Q34 Details.PropertyAddress4
Postcode
$
$
Interest rate per
Purpose of the loan
No
the lease
Yes
$
Fields on page 7
How many weeks per year
No
Yes
Give details below
Source of income (for example, hobby farming, agistment)
$
No
Yes
Give details below
No Yes
No
understand that me, or the person noted
Yes
Person to be contacted by the valuer
Person’s daytime phone number
If the property is hard to locate, give full directions or provide a map.
Fields on page 8
Real estate details (Mod R) form for each property
Copy of the latest council rate/valuation notice
Documents to show details of each water asset
Copy of each title deed
Documents to provide evidence of the property
Your mortgage or loan agreement(s) showing which
Copy of the last Income Tax Return, rental profit/loss
Copy of your last personal and business Income Tax
Your signature
Date
Your partner’s signature
Date
