LOAN APPLICATION FORM

Step 1. Purpose of Loan

Please allow 5-10 minutes to complete the application. Your Account Manager will contact you once received. Please call 09 489 6531 if you have any questions.

 

Please choose Personal Loan for secured or unsecured cash loans or Debt Consolidation to replace your debts withone new loan.

 

Is this a new application? Or guarantor to support a loan application?	New Application Guarantor
Loan Purpose?	Personal Loan Debt Consolidation

Loan Purpose: Personal Loan
Borrow up to $7,500 unsecured from 14.95%, up to 36 months to pay
How much would you like to borrow?	$

Loan Purpose: Debt Consolidation
Loan Amount?	$

Loan Term?

6 months 12 months 18 months 24 months 36 months 48 months 60 months

 

Step 2. Please tell us about yourself
Please answer all of the fields so that we can provide a prompt approval

 

First Borrower
Title	Mr Mrs Miss Ms
First Name
Middle Names
Surname
Preferred Name
Address
City
Postal Code
Date of Birth (dd/mm/yyyy)
Marital Status	Married Single De-facto
Number of Dependants
Time at Current Address	Years   Months
Previous Address
Previous City
Time at Previous Address	Years   Months
Home Phone Number
Mobile Number
Email Address
Drivers Licence Type	Full Restricted Learner None
Drivers License Number (5a)
Drivers License Version (5b)
Residency Status	NZ Citizen NZ Resident Work Permit Other
Residential Status	Renting Mortgage Boarding Freehold Living with Parent
Mortgage / Rent Amount (Monthly)	$
Take Home Pay (monthly - or select below)	$
Take Home Pay Frequency	Monthly Weekly Fortnightly Varies
Other Income (monthly)	$
Type of other income (i.e dividends)
Are you Self Employed?	Yes   No
What is your Occupation?
Occupation Type?	Full time Part time Casual Seasonal Contractor
Current Company Name / Employer
Company / Employer Phone Number
Time at Current Job	Years   Months
Previous Occupation
Previous Company Name / Employer
Previous Company / Employer Phone Number
Time at Previous Job	Years   Months

Is this a Joint Application?

Yes   No

Second / Joint Borrower
Title	Mr Mrs Miss Ms
First Name
Middle Names
Surname
Preferred Name
Address
Use First Borrower Address
City
Postal Code
Date of Birth (dd/mm/yyyy)
Marital Status	Married Single De-facto
Number of Dependants
Time at Current Address	Years   Months
Previous Address
Use First Borrower Address
Previous City
Time at Previous Address	Years   Months
Home Phone Number
Mobile Number
Email Address
Drivers Licence Type	Full Restricted Learner None
Drivers License Number (5a)
Drivers License Version (5b)
Residency Status	NZ Citizen NZ Resident Work Permit Other
Residential Status	Renting Mortgage Boarding Freehold Living with Parent
Mortgage / Rent Amount (Monthly)	$
Take Home Pay (monthly or select below)	$
Take Home Pay Frequency	Monthly Weekly Fortnightly Varies
Other Income (monthly)	$
Type of other income (i.e dividends)
Are you Self Employed?	Yes   No
What is your Occupation?
Occupation Type?	Full time Part time Casual Seasonal Contractor
Current Company Name / Employer
Company / Employer Phone Number
Time at Current Job	Years   Months
Previous Occupation
Previous Company Name / Employer
Previous Company / Employer Phone Number
Time at Previous Job	Years   Months

 

Step 3. Your Assets

 

Do you own your home?	Yes   No
Address
City
Current Government Valuation	$
Mortgage Balance	$

House Hold Contents Value	$
Do you have a Guarantor?	Yes   No

Do you own a Motor Vehicle?

Yes   No

Make and Model			Year
Registration Number			Value	$
Use vehicle as security?   Yes   No
Click here to add another vehicle
Make and Model			Year
Registration Number			Value	$
Use vehicle as security?   Yes   No
Click here to add another vehicle
Make and Model			Year
Registration Number			Value	$
Use vehicle as security?   Yes   No

Other Assets Value	$
Other Assets Description
Other Assets Value 2	$
Other Assets Description 2

 

Step 4. Your Liabilities
Please tell us about all the Loans, HP’s, Store and Credit Cards etc that you have in your name or that you are making payments for. This will assist us to determine your affordability and maximum lend. It’s important that you declare all of them for a prompt approval.

 

Please list all unsecured term loans that you may have. i.e. bank loans, cash loans etc
Loan Company			Monthly Instalment Amount	$
Loan Balance	$		Consolidate this Loan?	Yes   No
Cick here to add another Loan
Loan Company			Monthly Instalment Amount	$
Loan Balance	$		Consolidate this Loan?	Yes   No
Cick here to add another Loan
Loan Company			Monthly Instalment Amount	$
Loan Balance	$		Consolidate this Loan?	Yes   No

Please list all credit cards and store cards that you may have
Type of Credit Card			Card Limit	$
Card Balance	$		Consolidate Card?	Yes   No
Cick here to add another Credit Card
Type of Credit Card			Card Limit	$
Card Balance	$		Consolidate Card?	Yes   No
Cick here to add another Credit Card
Type of Credit Card			Card Limit	$
Card Balance	$		Consolidate Card?	Yes   No

Please list all secured loans that you may have such as retail hire purchase agreements or car loans
HP Company			Monthly Instalment Amount	$
Balance	$		Consolidate this HP?	Yes   No
Cick here to add another Hire Purchase
HP Company			Monthly Instalment Amount	$
Balance	$		Consolidate this HP?	Yes   No
Cick here to add another Hire Purchase
HP Company			Monthly Instalment Amount	$
Balance	$		Consolidate this HP?	Yes   No

Please list any other loans or debts that you may have here
Other			Instalment Amount	$
Balance	$		Consolidate this Loan?	Yes   No
Cick here to add another Loan or Debt
Other			Instalment Amount	$
Balance	$		Consolidate this Loan?	Yes   No
Cick here to add another Loan or Debt
Other			Instalment Amount	$
Balance	$		Consolidate this Loan?	Yes   No

 

Step 5. Alternate Contacts and Acceptance
Please provide us with two alternate contacts being friends or family not living at the same address. We will not contact these people as part of this application and will only contact them in the event of default.

 

Name of Family Member / Friend
Their current residential address
City
Their home phone number
Your relationship with them
Name of Family Member / Friend
Their current residential address
City
Their home phone number
Your relationship with them

How did you hear about us?	TV Radio Search Engine Word of Mouth Signs Previous Customer Another Finance Company Banner Ad
Referral Code (If any)
Preferred method of contact	Phone Email
	Can we contact you at work?

Please acknowlege that you have read our Privacy Act policy by clicking this box:
I have read and understand the Privacy Act policy
Any additional information to support your application

Thank you for your loan submission, you will shortly receive an email advising you that the application has been received. Thank you.