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 Application Form

Loan Details
Loan Required $    
Term of Loan    
Purpose of Loan    
How did you hear about Kiwiloans?    
Other    

Personal Details
  Applicant One   Applicant Two
Title  
Surname  
Firstname  
Middle Name  
Date of Birth  
Marital Status  
Number of Dependants  
      Leave blank if details are the same
Age of Dependents  
Current Address  
Current Suburb  
Current City  
Status  
Rent / Mortgage per month  
Time at Current Address  
Previous Address
(if less than 2 years at current)		  
(if less than 2 years at current)
Previous Suburb  
Previous City  
Time at Previous Address  
Home Phone  
Work Phone  
Mobile Phone  
Email Address  
Drivers Licence Number  
Licence Class  

Employment Details
Current Occupation  
Current Employer  
Time with Current Employer  
Address  
Suburb  
City  
Previous Occupation  
Previous Employer  
Time with Previous Employer  
Monthly Take Home Pay(net)  
  (Proof will be requested)   (Proof will be requested)
Other income  

Private Reference
Name  
Address  
Address Suburb  
Address City  
Phone  

Nearest Details
Nearest relative
(Not living with you)		  
Address  
Address Suburb  
Address City  
Relationship  
Phone number  

Security Details
  Vehicle One   Vehicle Two
Vehicle Value  
Vehicle Make  
Vehicle Model  
Year  
Financed By  
Amount Owing  
Registration number  

Asset Details
Bank $ $
Furniture $ $
Other $ $
Business Equity $ $
  Only fill this out if you OWN the property
  Property One   Property Two
Address  
Name(s) on title of house  
Value (GV or registered value)  
  a copy of your rates demand or valuation is needed as proof    
Mortgage balance
 
  a copy of your rates demand or valuation is needed as proof    

Liabilities

Type

Owed To

Monthly Payment

Amount Borrowed/
Card Limit

Amount Owing

 Will these be consolidated?
y
n
y
n
y
n
y
n
y
n

Previous Credit History
Previously had a loan?

y

n

 

 
if yes, who with?    
Best time to contact me    
Contact me on    

Privacy Policy
Privacy Act Acknowledgement
ACKNOWLEDGEMENT: To KiwiLoans New Zealand (2006) Ltd (“KiwiLoans”)
 
I/We have applied for finance and authorise KiwiLoans to forward my/our application to their accredited finance companies.

I/We understand that there is no obligation to provide personal information but failure to do so may prejudice my/our chance of obtaining finance.

I/We declare the information contained in this application is true and correct.

I/We authorise KiwiLoans to make all necessary enquiries and receive information concerning my/our credit rating, residence and employment from other credit providers, credit reporters, my/our employer/s, accountant/s and other named person/s or relative/s as is necessary for the purpose of considering this application.

I/We agree that KiwiLoans may produce this authority to such parties for this purpose.

I/We understand that KiwiLoans will give my/our personal information to credit reporters and that those credit reporters may hold the information on their systems and disclose it to authorised users of the credit reporters’ services.

I/We also understand that KiwiLoans may disclose to any credit provider named in a credit report relating to me/us information about my/our creditworthiness and credit history.

I/We acknowledge that if KiwiLoans provides finance it may collect and monitor such personal information about me/us as is necessary for the administration and protection of such credit (including without limitation utilising any credit reporters’ monitoring services to receive updates if the information held about me/us changes), and may disclose any payment default information to credit reporters which may hold the information on their systems and disclose it to authorised users of the credit reporters’ services. KiwiLoans may also (if necessary) disclose my/our personal information to fraud reporting agencies, and to any person KiwiLoans may appoint to assist in enforcement of any agreement between KiwiLoans and me/us.

I/We agree that where I/we have requested insurance cover through KiwiLoans, KiwiLoans may disclose such personal information to Autosure New Zealand and/or Protecta Insurance or other insurer as is necessary to enable those companies to consider that request.

I/We authorise KiwiLoans to use all personal information held about me/us now or in the future to offer me/us further finance, to consider any future application for finance from me/us, and to provide me/us with details of other products and services from time to time.

I/We agree that KiwiLoans may disclose and exchange all personal information held about me/us now or in the future including, without limitation, the amount of my/our indebtedness to any of their accredited finance companies where they are considering discharging that indebtedness on my/our behalf, for the purposes of marketing their products and services and to enable the KiwiLoans to monitor and maintain its introducer facility with their accredited finance companies. The personal information will be held at the offices of KiwiLoans. Where the personal information may readily be retrieved, I/we shall have access to it and the right to request correction. For the purposes of this Acknowledgement the term KiwiLoans includes any member of the KiwiLoans Group of Companies.
 
  I have read and accept the Privacy Policy and I accept the above terms - Yes
  Drivers Licence Number Applicant 1 Expiry Date
  Drivers Licence Number Applicant 2 Expiry Date
(Copy will be required)
 
   
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