Finance Application

More than One Applicant? *
NoYes

Application Name *
Date of Birth *
Country of Citizenship *
Country of Birth *
Relationship Status *


No. of Dependants *


Applicant Company Name (if Commercial Application)
Are you registered for GST? NOYES

Contact Phone *
Mobile Phone *
Email Address *
We may require further information for your application - what is the best way to contact you? *
Contact PhoneMobile PhoneEmail


Application License Number(5a) *
Application License Version(5b) *
Application License Expiry Date *
Application License Type *


Vehicle Interested In *
Vehicle Type *

Vehicle Being Traded?* NOYES


Application Name
Date of Birth
Country of Citizenship
Country of Birth
Relationship Status


No. of Dependants


Applicant Company Name (if Commercial Application)
Are you registered for GST? NOYES

Contact Phone
Mobile Phone
Email Address
We may require further information for your application - what is the best way to contact you? *
Contact PhoneMobile PhoneEmail


Application License Number(5a)
Application License Version(5b)
Application License Expiry Date
Application License Type


Vehicle Interested In
Vehicle Type

Vehicle Being Traded? NOYES

Current Address *
Current Suburb *
Current City *
Residential Status *

Time at Current Address *
Years      Month

Time at Previous Address
Years      Month

Previous Address
Previous City

Occupation *
Time in Current Role *
Years      Month

Current Employer *
Contact Number of Employer *
Previous Employer
Time in Current Role *
Years      Month

-----------------------------------


Occupation
Time in Current Role
Years      Month

Current Employer
Contact Number of Employer
Previous Employer
Time in Current Role
Years      Month

Property
Furnishings
Bank Savings
Kiwisaver
Other Investments
Please State Other Investments
Mortgages
(Balance) (Monthly Repayment)

Credit Cards
(Balance) (Monthly Repayment)

Personal Loans
(Balance) (Monthly Repayment)

Vehicle Loans
(Balance) (Monthly Repayment)
Other Hire Purchases/Credit Accounts
(Balance) (Monthly Repayment)

Rent Amount Per Week (if not mortgaged)
Average Net Monthly Income (after tax) Spouse's Average Net Monthly Income (after tax) Other Income: Please State Other Income:

Please provide us with any other information that will assist your application.

a) PRIVACY ACT 1993: I/We irrevocably authorise any person to provide you with such personal information concerning me/us as you may require in response to your credit and/or employment enquiries.I/We further irrevocably authorise you to furinish to any lender or third party any personal information concerning me/us including details of this application and any subsequent dealings that I/we have with you as a result of this application being action by you.I/We further authorise such lender or third party to make further enquiries (now or in the future) which may be necesasary in connection with this application and any agreement I/we may enter into as a result of this application.Where the personal information may be readily retrieved, I/we shall have access to it and the right to request correction.b) I/We apply for the above loan and certify that the particulars supplied are true and correct, and that I/we are over the age of 18 years and I am/we are not an undischarged bankrupt.