Loan Review QRAA. Name. Trading name. Client ID

Transcription

1 QRAA - GPO Box 211 BRISBANE Q 4001 Telephone: (07) Freecall: Facsimile: (07) contact_us@qraa.qld.gov.au Website: ABN: V4 01/04/14 Loan Review QRAA Name Trading name Client ID The following information is currently held by QRAA. Please indicate if the details held by QRAA are correct or provide an update where required. Please tick if the information below is correct: Yes If not, please update your details below. Contact details Update your details Residential address Postal address address Phone number Mobile number Fax number Contact person Phone number Great state. Great opportunity.

2 Section 1 - Statement of Assets and Liabilities - Primary Producers and Small Businesses Complete one Statement of your business and personal Assets and Liabilities including those held individually or jointly with partners, other persons or associated entities. The Statement must include all assets you own and all debts you owe. ASSETS (Show present fair market value) Cash at Bank Term Deposits $ $ LIABILITIES (Current amount owing) Overdraft [Limit:$ ] Term loans Farm Properties 1. [ ] $[ ]ha QRAA loans 2. [ ] $[ ]ha 3. [ ] $[ ]ha Other Loans (eg. Private Loans) Livestock/stock (show type) Fishing Vessel(s) Fishing License(s) Plant & machinery Vehicles Crops (harvested, stored and unsold) Stock Loans/Pastoral House Hire Purchase, Leasing & Chattel Mortgage (transfer total from table below) Entitlements Owing to Employees Taxation Debt Accounts Receivable Accounts Payable Debentures/Shares/Investments Other Real Estate (show details) Margin Loans Real Estate Loans (show details) Superannuation (current estimated value) Life Insurance (estimated surrender value) Other Assets (detail) Personal Loans Credit Cards Limit: $ [ ] Other Liabilities Limit: $ [ ] ASSETS LIABILITIES Hire Purchase and Lease Repayment Schedule Item Lender (a) Instalment INSTALMENTS Frequency eg. Monthly/ Yearly (b) No. of payments remaining Date of final payment (c) Overdue payments (Arrears) LEASE RESIDUAL (d) Due Date Owing (a x b + c + d) Owing (transfer total to Statement of Assets and Liabilities above) QRAA Loan Review Form - pg 2 of 5

3 Section 2 - Insurance If QRAA holds security over your property, fishing/other vessel or other vehicles/equipment which you are required to keep insured, please confirm insurance is current. We confirm that all assets used as security are insured for their market/replacement value (as appropriate). If fishing/other vessel - please attach latest survey report (if applicable) and current insurance certificate. Section 3 - Changes to property / assets / fishing vessel Yes N/A Please provide the details of any purchases or sale of any property, assets or fishing vessel since your last review. No change Purchased (please describe) Sold (please describe) Section 4 - Business performance / progress of business plans Please comment on the achievements and challenges for your business over the past year, and if applicable, business plan progress since your last application/review. Also, if this is your first review please comment on how the funds are benefiting your enterprise. Section 5 - Progress toward meeting Mutual Obligation development milestones Are you required to meet Mutual Obligation milestones as part of your First Start or Sustainability Loan? (please refer to your facility letter) Yes No (go to section 6) Mutual Obligation milestone Steps taken to satisfy the milestone QRAA Loan Review Form - pg 3 of 5

4 Section 6 - Current livestock numbers Do you operate a livestock primary production enterprise? Yes No (go to section 7) If yes, please enter your current livestock numbers below. Tot Beef (AE) Calving (%) Losses past year Beef/Dairy sheep (DSE) Lambing (%) Losses past year Sheep Herd Breed: Herd Breed: Current Target Cows Heifers Steers Ewes Wethers Hoggets Sows Gilts Boars Growers Calves Lambs Licensed for: SPU s Bulls Rams No. litters/ sow/year Av no. live Breeders Ewes piglets/litter Pigs sold/ Milkers sow/year Pigs Av sale Av sale Farrowing (%) weeks kgs Other livestock Herd Breed: Losses past year Section 7 - Authorisation I/We hereby authorise QRAA to obtain and disclose such information as considered necessary in relation to this review from my/our Accountants, Solicitors, Business Consultants, Commercial lenders (e.g. Banks and other Financiers), other Government Departments, Regional and Shire Councils, Suppliers, Processors or other agents. I/We certify that all of the information provided in the whole of this application is true and accurate and discloses our correct financial position. All business owners, directors or trustees must sign below. Applicant (1) Applicant (2) $ Applicant (3) Applicant (4) Privacy Information We understand and appreciate that our customers are concerned about their privacy and the confidentiality and security of any information that may be provided to us. QRAA has always prided itself on its standards of confidentiality, and will continue those standards, in line with new privacy legislation. The personal information collected and maintained by QRAA comprises your name, address, contact details and information specific to the support program. QRAA may use your personal information in order to provide the services you require, administer and manage those services, and research and develop our services. Your personal information is also collected to advise or offer information on other support programs that may be relevant and of interest to you. If you do not wish to receive these offers or information, please call and ask for the Privacy Contact Officer. It should be noted that financial information received by QRAA for the purposes of assessing eligibility and level of assistance under specific schemes of support, that may enable an individual to be identified, at no stage is divulged to any third party or government department. QRAA Loan Review Form - pg 4 of 5

5 QRAA - GPO Box 211 BRISBANE Q 4001 Telephone: (07) Freecall: Facsimile: (07) contact_us@qraa.qld.gov.au Website: ABN: A separate copy of this form is to be completed by each of your lenders. Please arrange for your lenders to return this form to you before submitting your completed review to QRAA. all related entities) To: (Bank/Financier Name) Please list below details of all my/our accounts held with your company and return this form to me/us according to the Return Instructions (shown to the right of this form). You are also authorised to discuss my/our accounts with QRAA and provide any information QRAA may request regarding my/our accounts. Name/Company/Firm Name/Director/Partner Schedule of Account Details Consent and Authorisation Applicants Applicants Return Instructions Please return this form to me/us by: Fax ( ) Post OFFICE USE ONLY Client ID No: QRAA V4 01/04/14 Loan Accounts, Equipment Finance & other Borrowings (Debit Accounts) Account Name Account BSB & Number Facility Type Balance Limit Interest Rate Expiry Date Repayment Repayment Frequency Balloon or Residual Arrears Contingent Liabilities: Savings Accounts, Term Deposits, Investment Accounts & other Asset Accounts (Credit Accounts) Account Name Accounts BSB & Number Account Type Balance line with conditions prevailing at the time of any such request and the lender s usual credit requirements Branch Address/Stamp Manager Name Manager Address Phone Number Date Fax Number QRAA Loan Review Form - pg 5 of 5 Great state. Great opportunity.