<p>SmartSuite Fax header Loan centre – Broker network</p><p>Adelaide Bank Adviser code: Number of pages including the cover sheet:</p><p>Broker Group: Fax to: Adelaide Bank Brokers name: 1300 ADL FAX (1300 235 329) Phone: 1300 791 679 Fax number: Phone number: Mobile number: Email address: </p><p>LOAN APPLICATION DETAILS</p><p>Adelaide Bank loan reference number (existing) Borrower(s) </p><p>Guarantor(s) Indexers please note if guarantor listed Product 1 Product 2 (If split loan)</p><p>Product type (please be specific)</p><p>Loan amount $ $ Loan purpose </p><p>State of 1st security WA NSW VIC ACT QLD TAS SA NT TBA Settlement date </p><p>FHOG application attached YES NO</p><p>Loan type New loan Variation Additional loan </p><p>Loan increase YES NO Loan number: Notes: </p><p>Privacy and confidentiality notice: The information contained in this facsimile is confidential and intended for the named recipients only. If you are not the intended recipient, you must not copy, distribute, disclose or take any action in reliance on the information contained in this facsimile. If you have received this facsimile in error please notify us immediately. Adelaide Bank a Division of Bendigo and Adelaide Bank Limited ABN 11 068 049 178. GPO Box 1048 Adelaide South Australia 5001 adelaidebank.com.au</p><p>27/06/2011 ABL0289b</p>