Personal Finance Application

Personal Information
Contact Information
Drivers Licence
Current Address
Previous Address (Optional)
Current Employment
Previous Employment (Optional)

Financial Information

Income, please fill out as much as you can and include all figures in NZD.
Assets, please include as many as you can with all figures in NZD

Liabilities & Expenses

Please include as many as you can with all figures in NZD
Leave empty if unapplicable
Loan or hire purchase
Leave empty if unapplicable
Credit card
Leave empty if unapplicable
Bank overdraft
Leave empty if unapplicable
Any other liabilities
Leave empty if unapplicable
Living expenses
Leave empty if unapplicable

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You are protected by responsible lending laws. Because of these protections, the recommendations given to you about this loan are not regulated financial advice.


Consent to the Obtaining and Disclosure of Information for AML Purposes
Authorisations and Consents: I authorise You as follows:

  1. Obtain Information for AML Purposes: You are authorised to make inquiries about me and to obtain information about me (“Personal Information”) as may be necessary to enable You to verify my identity as required from time to time by the Anti-Money Laundering and Countering Financing of Terrorism Act 2009 and regulations (“AML Laws”). This authority includes making inquiries of and obtaining my Personal Information from the Register of Drivers Licences, any other public register or database, any credit reporter or any other source that You consider is desirable in order to perform your obligations under the AML Laws. If electronic verification of identification cannot be confirmed using any credit reporter satisfactory to You, additional identification documentation to the standard required will be requested to enable any application for credit to be processed.
  2. Disclose Personal Information for AML Purposes: You are also authorised to disclose my Personal Information obtained by You pursuant to this consent to any person or organisation to whom you may or must disclose it under the AML Laws or any other applicable laws, including to any credit reporter in order to assist them to provide identity verification information to their customers, and I consent to and authorise any such credit reporter or other person also disclosing my Personal Information to their customers for those purposes.
  3. Hold Personal Information for AML Purposes: You and any person or organisation to whom you are permitted to disclose my Personal Information may hold it in any manner permitted by the Privacy Act for so long as You or they are required to do so in order to comply with the AML Laws or any other applicable laws. Other Acknowledgements:
  4. My Right of Access to Information You Hold: I understand that l have the right to access, and to correct, Personal Information held by You pursuant to this consent.
  5. Voluntary Signing: I understand that I am under no obligation to sign this consent or to provide You with any Personal Information (including any drivers licence information we may give You), and I do so voluntarily.
  6. Consequences of Not Signing: I also understand that failure by me to provide You with this consent may result in You declining any application to You for credit in connection with which You have requested meto provide this consent, and/or the provision of related services provided by You.

Information Statement/Authorisation Pursuant To The Privacy Act 1993 Please read this statement notice in full.
Have you ever had or are there now any attachments or legal proceeding against you, or any action for payment default?*

Consent & Authorisation
I apply for a loan and certify that the particulars above and overleaf 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 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.

Accuracy of Information
Please ensure that you have checked the details provided and that you are happy that they accurately reflect your application for Personal Credit. Inaccurate information may lead to issues in accepting your application.