Apply for a Loan

Loan details

1. 1. How much would you like to borrow?*
   2. How much could you comfortably repay?*
   3. Payment optionPer week Per fortnight Per month
2. Why do you need or want this money?*

3. If you have insufficient security or ....... for the full amount you want then we might offer you approval for a lesser amount.

1. Your personal details

   1. Your full name

      1. Title*
      2. First name*
      3. Middle name
      4. Last name*
   2. Marital statusSelect Single De Facto Married Civil Union Separated / Divorced Widowed
   3. Date of birth* Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907
   4. Your home or work phone number*
   5. Your mobile number
   6. Your email address

   7. Employment and income

      1. 1. Your current occupation
         2. Your current employer
         3. Your employer's phone number
         4. How long have you been in your current job?Select Less than 1 year 1-2 years 2-3 years 3+ years
      2. 1. Previous occupation
         2. Previous employer
         3. Previous employer's phone number
         4. How long were you in your previous job?Select Less than 1 year 1-2 years 2-3 years 3+ years

2. Your partner's personal details

   1. Their full name

      1. Title
      2. First name
      3. Middle name
      4. Last name
   2. Their date of birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907
   3. Their home or work phone number
   4. Their mobile number
   5. Their email address

   6. Employment and income

      1. Their current occupation
      2. Their current employer
      3. Their employer's phone number
      4. How long have they been in their current job?Select Less than 1 year 1-2 years 2-3 years 3+ years

1. 1. OR

   2. Your New Zealand driver's license

      1. Number (5a)
      2. Version (5b)
   3. When does your New Zealand driver's license expire? Month January February March April May June July August September October November December Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

2. 1. Your passport details

      1. Passport number
      2. Country of issue
   2. When does your passport expire? Month January February March April May June July August September October November December Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

1. What is your current living situation?
   1. Own home
   2. Renting / Flatting
   3. Boarding / With parents
2. 1. Your current residential address*
   2. Suburb*
   3. City*
   4. How long have you been at this address?Select Less than 1 year 1-2 years 2-3 years 3+ years
3. 1. Your previous residential address*
   2. Suburb*
   3. City*
   4. How long did you live at this address?Select Less than 1 year 1-2 years 2-3 years 3+ years

1. Loan security and collateral

   1. I own a house and/or property
   2. I own furniture and/or appliances
   3. I own a car or motorbike
   4. Make of vehicle
   5. Year of manufacture
   6. Model of vehicle
   7. Vehicle plate/reg
   8. Vehicle insured by
   9. If there is money owing on this vehicle, who do you owe it to?
   10. What else do you own that could be used as security for your loan?

2. Guarantor

   1. Nominees name

      1. Title
      2. First name
      3. Middle name
      4. Last name
   2. Nominee's residential street address
   3. Suburb
   4. City
   5. Nominee's date of birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907
   6. I nominate this person as my guarantor

Credit references

1. Name and contact for credit references

2. People or businesses such as other lenders, utilities, phone companies that you pay money to who we can ask if you pay your bills in full and on time.

Terms and conditions

1. I/We warrant that the information given above is true and correct and hereby AUTHORISE this lender making all enquiries and obtaining all information it shall deem necessary at its discretion. I/We AUTHORISE all companies, institutions, credit agencies, organizations and other persons approached by this company for information about me/us to provide the information requested. i/We acknowledge that this company shall not be required to comply with the provisions of Principle 3 of the Privacy Act 1993 as to whether I/We shall be aware of:

   • The fact that the information is being collected
   • the purpose for which the information is being collected
   • the intended recipients of the information
   • the consequences for providing information
   • the rights of access to and correction of such information
   • or that the collection of the information is authorized or required by or under law