Loan Application

 
PURCHASE INFORMATION
Retailer Name      
Description of goods     Value of Goods   
Apply for Wedding Card
Payment Frequency  
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     Term (Months)
    
CUSTOMER INFORMATION -
Salutation
select
   
Given Name   Middle Names
Surname  
Type of Identity  
select
Identity No   
Driver's Licence
version no 5B
  
Copy of Id
Date of Birth    
 dd/mm/yyyy
Vehicle Registration No
Residency    
select
   
Marital Status  
select
Number of Dependants
PHYSICAL ADDRESS
Street Address   Suburb  
Town / City   Post code
Years at this address
       
PREVIOUS ADDRESS (if less than 2 years at above address)
Full Address   Years at previous address
 
POSTAL ADDRESS (if different than physical address)
Street Address Suburb
Town / City Post code
CONTACT DETAILS
Home Telephone No.    Mobile Phone No.
Work Phone No. Email  
PERSONAL CONTACT ADDRESS 1 (not living with you)
Personal contact Name   Personal contact Address  
Personal contact Phone No.  
PERSONAL CONTACT ADDRESS 2 (not living with you)
Personal contact Name   Personal contact Address  
Personal contact Phone No.  
EMPLOYMENT
Employment Status  
select
Occupation
Employers Name How long at job?
Income Frequency  
select
Income (Before Tax)  
ASSETS
Home Owner
select
   
Value of Home (Approx) Balance of Mortgage(Approx)
   
CREDIT REFERENCE- LOANS OUTSTANDING : ($ Approximations Only)
Name of Company : Original Balance: Balance Owing: Monthly Payments:
  • YOU CONSENT TO OUR COLLECTING, HOLDING, USING AND DISCLOSING
     • A INFORMATION ABOUT YOU THAT YOU GIVE US AND
     • B OTHER INFORMATION WE GATHER ABOUT YOU (“PERSONAL INFORMATION”) AS FOLLOWS:

    So we may:
    1a) Verify what you tell us about yourself with third parties such as Government Agencies (including the Ministry of Justice The NZ Transport Agency and the Insolvency Service) credit reporters and debt collecting agencies. b) Carry out credit checks on you. c) Decide whether to lend you money, administer any loan and enforce payment. d) Comply with our obligations under the Anti-Money Laundering and Countering the Financing of Terrorism Act 2009 and the Credit Reporting Privacy Code 2004.
    2) In these processes we may provide your personal information to third parties and the credit reporting agencies and debt collectors may hold that information and may disclose it to other parties who wish to carry out credit checks on you or for other lawful purposes.

    [The Credit Reporter(s) we currently use are Veda Advantage (NZ) Limited, Private Bag 92156, Auckland Mail Centre Auckland 1142, and / or Centrix Group Limited P.O. Box 62512 Green Lane Auckland 1546]
    You declare that the information you give us is true and correct and you consent as shown above.