// Applicant Details
First Name: * Middle Name: Last Name: * Date of Birth: Drivers Licence:	First Name: Middle Name: Last Name: Date of Birth: Drivers Licence:
Licence version: Living Status: -Renting- -Flatting- -Boarding- -Own Home- Marital Status: -Married- -De facto- -Separated- -Single- -Other- Dependents: Current Address: City: Time at address:  Months    Years Home Phone: Fax Number: Mobile Phone: Email Address: *	Licence version: Living Status: -Renting- -Flatting- -Boarding- -Own Home- Marital Status: -Married- -De facto- -Separated- -Single- -Other- Dependents: Current Address: City: Time at address:  Months    Years Home Phone: Fax Number: Mobile Phone: Email Address:
// Applicant Details
Employment: Applicant One Occupation: Time at occupation:  Months    Years Employer: Address: City: Phone Number: Mobile Phone: Previous Occupation: Time at occupation:  Months    Years Previous Employer:	Employment: Applicant Two Occupation: Time at occupation:  Months    Years Employer: Address: City: Phone Number: Mobile Phone: Previous Occupation: Time at occupation:  Months    Years Previous Employer:
// Vehicle Details
Purchase Vehicle Details Branch: Hastings Gisborne Napier Make: Model: Year: Stock NO#: Rego No#:	Trade-In Vehicle Details   Make: Model: Year: Mileage: Rego No#:
// Loan Details
Vehicle Price: Cash Deposit: Less Trade-In: Amount Required:
// Terms
I apply for a loan and certify that the particulars above 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 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.
Please ensure the details you have provided above are correct before submitting the application.