NILS Enquiry Form

Date *

First Name

Last Name

Date of Birth *

Email Address

What is the loan for? *

Loan Amount? *

How did you hear about NILS? *

Preferred Contact Method *

PhoneEmailSMSLetter

Contact Number

Residential Address *

Street address *

City *

State *

Postcode *

Postal Address if different from Residential Address

Street address

City

State

Postcode

What best describes your income per year? *

You are single and earn under $75 000 per yearSingle person with dependents $100 000 or underCouple $100 000 or underYou are a couple with dependants and earn under $100 000 per year

Health Care Card or Pension Card *

YesNo

Has your income been reduced or expenses increased due to Covid 19? *

YesNo

Are you an Australian Citizen? *

YesNo

If applicable, please enter (or estimate) the date you first arrived in Australia

Your Accommodation? *

Your living arrangements? *

Length of time at current address? *

How many children/dependants do you have ?

Secondary Contact or Joint Application - Client Explanation *

First and Second Name

Your relationship to each other?

Your gender identity

FemaleMaleOther

Aboriginal & Torres Strait Islander

AboriginalTorres Strait IslanderAboriginal & Torres Strait IslanderPrefer not to answer

Do you identify as having a disability?

YesNo Prefer not to answer

Are you and NDIS participant?

YesNoNot sure

Do you require an interpreter to meet with us?

YesNoNot sure

If yes, which language do you prefer?

What is your highest level of education? *

Your current employment status? *

What is your gross annual income? (the amount before tax) *

Please read the following. Depending on your records, please upload the most relevant proof of identification documents from this list. You can upload a copyof each at the UPLOAD link below.

Identification Documents *

Drivers License or Passport or Birth CertificateMedicare CardCentrelink Income and Deduction Statement

List of documents you will be supplying, please tick all that apply.

List of Documents you are uploading *

Upload your files here

Browse

To access your Bank Statements you need to go to:

https://scv.bankstatements.com.au/NILS-TCYP

This is a safe and secure way that banks and financial institutions access your bank statements. Please refer to our webpage for more information on how your data and information is kept safe.

In submitting this form you are agreeing: *

that I have applied for a NILS loan via The Community Placethat by singing this agreement all the information supplied is true and correct to the best of my knowledgeI agree if the loan is approved that I will replay the nominated amount until the loan is fully repaidI agree that I will contact The Community Place if my contact details change whilst repaying my loanI agree I will contact The Community Place if I have difficulty with my repaymentsI agree that The Community Place can contact me about my loanI understand that when I repay my loan, other people in the community will be able to have a NILS loan

Click YES to agree *

YES

I agree to the conditions listed above for this loan application (Client 1)

First *

Last *

I agree to the conditions listed above for this loan application (Client 2)

Second Applicant First Name

Second Applicant Last Name

I am human *