Image

 
 
Finance Application Form
*required please
Applicant:
(Surname)*
(First name, middle name) *
Marital Status: Number of Dependants:
Co Borrower's Name:
(Surname)
(First name, middle name)
Date of Birth:
(Applicant)
(Co Borrower)
Driver's Licence No: 5a

(Applicant) *

(Co Borrower)
Driver's Licence No: 5b
(Applicant) *
(Co Borrower)
Licence type: * Full Learners Restricted
Current Address:
Years there:
Tenancy: Own house   Renting   Boarding   Family home   Other
Other (Detail):
Previous Address:
Years there:
Email Address: *
Phone: (Private) *    (Business)    (Mobile)
Present Employer: Years:
Address: Occupation:
Previous Employer: Years there:
Co Borrower's Employer: Years there:
Address: Occupation:
Nearest Relative:
Address and Phone:
Relationship:
Name of a close friend:
Address and Phone:
Your bank: Account No:
Approximate Amount Required: $
Assets (please note all assets which are jointly owned) Joint Liabilities  
Home $ Mortgages $
Furnishings $ HP/Credit accounts $
Bank $ Bank O/D $
Car $ Other Creditors, or loans outstanding $
Investments $  
Other $ Total $
 
   
Total $   Net worth $
Income (monthly)   Expenses (monthly)  
Average take home pay: $ Mortgages/Rent payments $
Co Borrower's take home pay: $ HP and Credit accounts $
Other Income $ Rates, phone, power, insurance $
 
Life insurance, Building Society $
Total $ Car and other expenses $
     
    Total $

Information Statement/Authorisation Pursuant To The Privacy Act 1993
Please read this statement/authorisation notice in full.

Have you ever had or are there now any attachments or legal proceeding against you,
or any action for payment default? * Yes No
If yes, please state details:
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.
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.

I have read and accept the terms and conditions within this informative statement/authorisation.

* I Accept Terms And Conditions

Please ensure the details you have provided above are correct before submitting the application.