| Title |
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| * First Name |
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| Middle Name |
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| * Last Name |
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| Date of Birth |
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Day Month Year |
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| To apply for these services, you must be 18 years old or older. |
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| Drivers License NO. |
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Type
Version Number
(shown after your number e.g. 003)
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Current Address
(where are you living now?) |
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| Period there |
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years months |
Previous Address
(If current is less than3 years) |
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| Period at the above address |
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years months |
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| * Email Address |
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Telephone Home
(Incl.area code) |
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Telephone Work
(Incl.area code) |
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| Mobile |
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| Marital Status |
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| Number of Dependants |
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| Ages of children |
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| Your Occupation |
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| Employer's Name |
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Employer's Phone Number
(Incl.area code) |
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| How long have you been in this job? |
|
years months |
| Previous Occupation |
|
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| Previous Employer |
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| Period of Previous Employment |
|
years months |
|
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Your Bank
(e.g. ASB, Westpac) |
|
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Branch
(location e.g. Auckland City) |
|
|
| |
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| Credit reference |
|
List some companies you have had credit with (e.g. Harvey Normans, Noel leeming,) |
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| Type of vehicle you are looking for? |
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| Deposit you wish to make? |
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| Cash Deposit yes / no |
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| If yes - Cash Amount |
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| Tradein yes / no |
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| How do you wish to be contacted? |
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Contact PhoneContact Email |
| Preferred contact time: |
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| INCOME DETAILS FOR SELF EMPLOYED PEOPLE ONLY |
| |
| Accountant(Only if self employed) |
|
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| Phone(Incl.area code) |
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| Fax(Incl.area code) |
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| INCOME DETAILS - ALL APPLICANTS |
| |
| Net Income Monthly (After tax income) |
|
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| Other Income |
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| Monthly Total |
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| STATEMENT OF FINANCIAL POSITION Assets (things that you own) |
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| Cash / Bank |
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| House Value |
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| Furniture / Fittings |
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| Motor Vehicles |
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| Investments |
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| Shares |
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| Others |
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| Total |
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| Liabilities (things that you pay out each month) |
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Mortgage Amount
(Total Owing) |
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| Mortgages payments per month |
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Monthly Payments
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| Rent per month |
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Monthly Payments
|
Credit Cards
(Total amount owing) |
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Total Amount
|
Credit Cards
(monthly amount owing) |
|
Monthly Payments
|
Hire Purchases
(Total amount owing) |
|
Total owing
|
| Hire Purchases |
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Monthly Payments
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| Others |
|
Monthly Payments
|
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Keep me up to date with
new offers and prize draws. |
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| Where did you hear about us? |
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| Yes I consent to a credit check |
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