Step 1 of 4 25% contact informationFull Name*Phone: Home*Phone: Mobile*Email* Physical Address*City*Post CodeTime at Address*Physical Address (If less than 2 years at current address)CityPost CodeTime at Address Personal informationDate of Birth* Date Format: DD slash MM slash YYYY Marital Status*MarriedSingleDefactoOtherDependants (Number)*NZ Citizen*YesNoOr VISA Status Drivers Licence InformationCountry*5a (Number from Drivers Licence)*5b (Number from Drivers Licence)*Expiry* Personal ReferencesReference 1 - Name*Relationship to YouAddressPhoneReference 2 - NameRelationship to YouAddressPhone Accommodation InformationCurrent Situation*RentingMortgageBoardingOther Living Situation (Please explain) Rent Details (If applicable)Agent / Landlord NameAgent / Landlord PhoneWeekly Rent Amount Mortgage Details (If applicable)BankProperty ValueAmount OwingMonthly Repayments Financial Information EmploymentOccupation*Length of Employment*Monthly Income (After Tax)*Employer Business Name*Employer PhonePrevious Employer (If current is less than 3 years)Previous Employer PhoneOther Income Source 1 (If Applicable)Monthly Income from Source 1 (After Tax)Other Income Source 2 (If Applicable)Monthly Income from Source 2 (After Tax) AssetsMotor Vehicle(s) ValueShares or Investments ValueBank Account(s) ValueEquity in Investment Property(s)Address(s) of Investment Property Owned Liabilities / Debts / Credit CardsBank / Lender Name 1Amount OwedMonthly PaymentsBank / Lender Name 2Amount OwedMonthly PaymentsBank / Lender Name 3Amount OwedMonthly Payments Discosure and Consent By ticking the box below, you agree that we may collect, hold, use and disclose your information for the following purposes: 1. Obtaining from, or disclosing to, any third party (including other credit providers and motor vehicle dealers) Information about you to assess, arrange, provide, administer or manage your credit application, account, facility, any guarantee and any insurance including responding to requests from you for information or variations. This includes disclosing information about your application, account, facility, any guarantee or insurance to motor vehicle dealers or business managers so they can help us carry out these purposes. You authorise the motor vehicle dealer or business manager to make requests to us for these purposes on your behalf and you consent to us disclosing the requested information in response. 2. Meeting our legal obligations including identifying and verifying you, and monitoring and screening your, or the company's, accounts in accordance with the Anti-Money Laundering and Countering of Terrorism Financing Act 2009 (AML/CFT Act). You understand the provision of your driver licence number for disclosure to a credit reporting agency is voluntary. * I give consent. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
