Borrower Application

Loan amount*

Please enter a value greater than or equal to 400.

Payment frequency*

I can afford to repay*

Reason for loan*

e.g buy a car, car repairs, debt consolidation (include car registration plates or trademe ref # of cars to be purchased)

Have you had a loan with us before?*

Yes
No

How did you hear about us?*

Please enter a Promo Code if you have one.

This could get you a special discount.

Your Personal Details

Gender*

Male
Female

Title*

First name*

Middle name(s)

Surname or last name*

Other names

e.g. maiden name, married name, former names

Relationship status*

Date of birth*

How many dependents do you support financially?*

e.g. Children that you look after

Contact Details

Email Address*

Mobile phone number*

Identification and Residency

Are you a NZ resident?*

Yes
No

Identification type?*

You need to provide photo identification

Passport Number*

Card Number*

Passport Number*

Card Number*

Licence number 5a*

Licence version 5b*

Please enter a value between 001 and 999.

Licence Type*

Expiry Date*

Do you have a criminal record?*

Yes
No

Details of criminal record*

Have you ever filed no asset procedure (NAP), summary instalment order (SIO) or been bankrupt?*

Yes
No

Details or NAP, SIO or bankruptcy*

Current Address

Road number and name of road/street*

Suburb/RD

Town/city*

Accommodation type?*

How long have you lived there?*

Current Employment

Employment status*

Occupation/Benefit type*

Employer*

How long have you been doing this?*

Prior Employment status*

Prior Employer*

How long were you doing this?*

Assets You Own

Do you own a house?*

Yes
No

Market value*

Mortgage balance*

Do you own any cars, trailers or truck?*

Yes
No

Make and model*

Year of manufacture*

Registration or number plate*

Is there finance owing on the asset?*

Yes
No

Name of lender*

Do you have insurance on the asset?*

Yes
No
TBA

Name of Insurer*

Do you own more cars, trailers or trucks?*

Yes
No

Make and model*

Year of manufacture*

Registration or number plate*

Is there finance owing on the asset?*

Yes
No

Name of lender*

Do you have insurance on the asset?*

Yes
No
TBA

Name of Insurer*

Estimated value of household assets*

e.g. Apliances, sporting goods etc.

Do you have any other assets*

Yes
No

Details of assets

Income

Your take-home pay

Per week

Your partners take-home pay

Per Week

Other income/benefits

Per Week

Expenses

Rent/Mortgage

Per Week

Additional Comments

Do you have any other comments or information to help us process your loan?

Who would you like to review your application?

Declaration

Please read our Term and Conditions and answer the following:

Borrower*

I have read and understand the terms and conditions and I can afford to make repayments

Finance application

Your Personal Details

Contact Details

Identification and Residency

Current Address

Current Employment

Assets You Own

Income

Expenses

Additional Comments

Declaration