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Please fill in the required fields
1. Applicant One - Information
First Name
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Middle Name
Last Name
*
Date of Birth
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| 13 | 26 | 27 | 28 | 29 | 30 | 31 | 1 |
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| 18 | 30 | 1 | 2 | 3 | 4 | 5 | 6 |
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Drivers Licence Number
Drivers Licence Version
Living Status
Marital Status
Dependants
Current Address
*
City
*
Time of Ownership
Years
Months
Home Phone Number
Work Phone Number
Mobile Number
Email
*
2. Employment - Applicant One
Occupation
Employer
Length of Employment
Years
Months
Employment Address
City
Employer's Phone Number
Employer's Mobile Number
Previous Occupation
Previous Employer
Previous length of Employment
Years
Months
3. Applicant Two - Information
First Name
Middle Name
Last Name
Date of Birth
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| 13 | 26 | 27 | 28 | 29 | 30 | 31 | 1 |
| 14 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| 15 | 9 | 10 | 11 | 12 | 13 | 14 | 15 |
| 16 | 16 | 17 | 18 | 19 | 20 | 21 | 22 |
| 17 | 23 | 24 | 25 | 26 | 27 | 28 | 29 |
| 18 | 30 | 1 | 2 | 3 | 4 | 5 | 6 |
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| Jan | Feb | Mar | Apr |
| May | Jun | Jul | Aug |
| Sep | Oct | Nov | Dec |
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Drivers Licence Number
Drivers Licence Version
Living Status
Marital Status
Dependants
Current Address
City
Time of Ownership
Years
Months
Home Phone Number
Work Phone Number
Mobile Number
Email
4. Employment - Applicant Two
Occupation
Employer
Length of Employment
Years
Months
Emplyment Address
City
Employer's Phone Number
Employer's Mobile Number
Previous Occupation
Previous Employer
Previous length of Employment
Years
Months
5. Purchase Details
Make
Model
Year
Stock Number
6. Trade-In Details
Make
Model
Year
Hours
Registration Number
7. Loan Details
Purchase Price
Cash Deposit
Less Trade-In
Amount Required
8. Assets
Home Value
Furnishings Value
Bank Balance
Vehicle Values
Investments
Other Assets
Your Total Assets
9. Liabilities
Mortgages
Hp and Cr Cards
Bank Over-draft
Other Creditors
Other Loans
Your Total Liabilities
Your Net Worth
10. Income Total Monthly
Take Home Pay
Other Income
Total Monthly Income
11. Expense Total Monthly
Rent
Mortgage Payments
HP and Cr Cards
Phone, Power etc.
Insurance
Car and other
Total Expenses
12. Comments
Comments or Questions
I apply for a loan and certify that the particulars above and overleaf are true
and correct and that I am over the age of 18 years and am not an undischarged bankrupt.
Pursuant to the Privacy Act 1993 I authorise any finance company to contact any
credit reporting agencies, credit providers, my employer(s), accountant(s), or any
other source, to obtain, check and exchange (both now and in the future) such personal,
financial and commercial information and references about me/us as is necessary
for the purposes of considering this application, the protection and administration
of any loan arising out of this application, and to assist in the enforcement of
any agreement between me/us and any finance company. I agree that you may produce
this authority to such parties for the purposes of collecting such information.
Under the provisions of the Privacy Act 1993, you are entitled to have access and
request correction to personal information held about you.
Information Declaration
I agree that the information in connection with this finance application may be
transmitted via facsimile and/or electronic mail, and I acknowledge that there may
be some security risks associated with the transmission.
Terms and Conditions
I have read and accept the terms and conditions within this informative statement/authorisation.
Please ensure the details you have provided above are correct before submitting
the application.