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APPLICATION FORM FOR FINANCE:
Step
1
of
5
20%
General Information
Title
(Required)
Mr
Mrs
Ms
Miss
Master
Name
(Required)
Company Name (Seller of Item)
(Required)
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Other
Marital Status
Married
De Facto
Civil Union
None
How many dependant children do you have?
Mobile
(Required)
Email
(Required)
Are you a current NZ Driver's Licence Holder?
(Required)
Yes
No
Please provide Licence Number, Version & Expiry Date
(Required)
Please provide Passport Details: Number, Date Issued & Expiry Date
(Required)
Please upload the FRONT page of your Driver's Licence
(Required)
Accepted file types: jpg, jpeg, png, gif.
Please upload the BACK page of your Driver's Licence
(Required)
Accepted file types: jpg, jpeg, png, gif.
Please upload your main Passport page
(Required)
Accepted file types: jpg, jpeg, png, gif.
NZ Citizen/Permanent Resident
Yes
No
Please provide Country of Citizenship
NZ Visa Holder
Yes
No
Please provide Visa Details: Visa Type, Term & Expiry Date
Loan Type
Personal Loan
Vehicle Loan
Asset Loan
Amount to be Financed
Financed Term
Accommodation
Current Accommodation Status
Renting
Boarding
Living with relatives
Homeowner
Cost of Accommodation
Cost of weekly/monthly rent/mortgage, e.g. $200
Frequency of Payment
Weekly
Fortnightly
Monthly
Yearly
Address
(Required)
Street Address
Suburb
City
Postcode
How long have you been living here?
Years
Months
Add
Remove
Previous Address (can be overseas)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
How long did you live there?
Years
Months
Add
Remove
Incomes
Type
Wages
Salary
Other
Take Home after Tax
Frequency
Weekly
Fortnightly
Monthly
Yearly
Current Employed Status
Full-time/Permanent
Part time/Permanent
Other
Work Type/Industry
E.g. Trade/Construction
How long have you been on current employed status?
Years
Months
Add
Remove
Current Employer Name
(Required)
Current Employer Address
Street Address
Suburb
City
Post Code
Did you work before?
Yes
No
How long had you been on previous employed status?
Years
Months
Add
Remove
Previous Employer
Company Name
Industry
Occupation
Add
Remove
Liabilities
Do you have any liabilities?
Yes
No
Personal Loan
Current Balance
Payment
Add
Remove
Frequency
Frequency
Weekly
Fortnightly
Monthly
Notes
Credit Card
Current Balance
Payment
Add
Remove
Frequency
Frequency
Weekly
Fortnightly
Monthly
Notes
Rates/Phone/Power
Payment
Add
Remove
Frequency
Frequency
Weekly
Fortnightly
Monthly
Notes
Vehicle Loan
Current Balance
Payment
Add
Remove
Frequency
Frequency
Weekly
Fortnightly
Monthly
Notes
Food
Payment
Add
Remove
Frequency
Frequency
Weekly
Fortnightly
Monthly
Notes
Other
Current Balance
Payment
Add
Remove
Frequency
Frequency
Weekly
Fortnightly
Monthly
Notes
Next of Kin
Next of Kin 1
Enter name of first next of kin
Contact Number 1
Enter contact number of your first next of kin
Relationship 1
E.g. Partner
Current Address 1
Street Address
Suburb
City
Post Code
Next of Kin 2
Enter name of second next of kin
Contact Number 2
Enter contact number of your second next of kin
Relationship 2
E.g. Partner
Current Address 2
Street Address
Suburb
City
Post Code
Consent
(Required)
I agree to the privacy policy.
To verify your acceptance of the above Privacy act statement please tick the box.
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