1
2
3
4
5
6
7
  1. Do you own or are you paying off a home or investment property?
  1. How much unsecured debt do you owe?
    (Include all credit cards, store cards, personal loans, pay day loans, overdrafts, tax debt, Centrelink, shortfalls from the sale of cars or property and any amounts owing to collections agencies and debt collectors.)
  1. What is your primary employment status?
  1. What is your annual gross income?
    (Include salary, overtime and bonuses)
  1. What annual gross income do you expect to earn?
    (Include salary, overtime and bonuses)
  1. Is your business registered for GST?
  1. Do you own shares, an unencumbered motor vehicle or other assets with a combined value of $15,000 or more?
  1. Do you own shares, an unencumbered motor vehicle or other assets with a combined value of $15,000 or more?
  1. What is your annual gross income?
  1. Do you own shares, an unencumbered motor vehicle or other assets with a combined value of $15,000 or more?
  1. How many properties do you have in Australia?

Property 1

  1. $
  1. $

Property 2

  1. $
  1. $
  1. Do you have a partner?
  1. Do you run your own business?
  1. Do you also receive income from a job?
  1. Have you been running your business for more than 12 months?
  1. Please list all your debts
  2. We can only help you if you disclose all your debts.
Credit Cards and Store Cards
  1. Total Owing $
Car Loans
  1. Total Owing $
Personal Loans and Pay-Day Loans
  1. Total Owing $
Collection Agencies/Debt Collectors
  1. Total Owing $
All other debts and outstanding bills including fines and taxes
  1. Total Owing $
  1. Total: $
What is your income including salary, overtime and bonuses?
  1. $
  2. Per
If you receive Centrelink, child support, rent, board or any other income, please enter the amount.
  1. $
  2. Per
© 2001 - 2025 Debt Relief Australia
ABN 35 091 225 357 Australian Credit Licence Number 393280 All Rights Reserved  |   Privacy Policy