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About your purchase

What is your loan for?*

What information do you have?*

Registration*

Trade Me listing #*

Make*

Model*

Year*

About the loan

Purchase/Refinance amount*

Deposit

Loan amount

About you

Title*

First name*

Middle name

Last name*

Date of birth*

Email address*

Mobile number*

Relationship status*

No. of dependents*

I have read and understood the Privacy Consent.

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Drivers Licence details

Drivers licence*

Drivers licence number

Item 5a on your licence

Version number

Item 5b on your licence

Personal details

Living situation*

Current address

Time at current address

Years

Months

Mortgage or rent payments

Employment details

Employment Type*

Occupation*

Employer*

Employer address

Name of business*

Business address

Time at current job*

Years

Months

Net Income*

Previous employer/Name of business

Previous employer address

Time at previous job

Years

Months

Assets and liabilities

Value

Amount owed

Monthly repayments

Cash in bank

Value:

Cash in bank

Home

Value:

Owed:

Monthly:

Home

Vehicles

Value:

Owed:

Monthly:

Vehicles

Boat

Value:

Owed:

Monthly:

Boat

Hire purchases

Owed:

Monthly:

Hire purchases

Personal loan

Owed:

Monthly:

Personal loan

Credit card

Owed:

Monthly:

Credit card

Other

Value:

Owed:

Monthly:

Other

Additional notes

Please inform us of any other relevant information

I declare that all the information given in this application is true, correct and up to date. I have read and agree to the Privacy Consent and Credit Quote.

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