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Enquiry Form

First Name:   
Last Name:   
D.O.B:   
Address:   
City:   
Postcode:   
Phone No:   
Email:   
     
1.Do you hold a current health care card, recieve a Centrelink income or have a low income?


 
2.Have you lived at the same address for at least 3 months or show a long term connection to the area?


 
3.Are you willing and have capacity to repay the loan?


 
4.Do you have any outstanding NILS loans?


 
5.How much do you want to borrow? (limit of up to $1,500)  
6.What do you want to buy?  
7.Is the item(s) new and being sold buy a registered business?


 
8.How did you find out about the NILS Program?  
     
 
   
 Contact details for Client Support Worker (If completing form on behalf of client)   
Name:   
Organisation:   
Phone:   
Email: