Application Form

Please enter all your details in here












How long have you lived here?


Previous address - if less than 3 years at the above address







Employment Details






How long have you been employed?


Identification - Drivers licence No. Passport No. etc









Relative NOT living with you - ( must be on the telephone )













Please Check all the boxes that best describe your position



















Please Check the reasons for your loan












Security for Loan - Vehicle










Security for Loan - Home







Security for Loan - Chattels







Security for Loan - Other






INFORMATION STATEMENT/AUTHORISATION PURSUANT TO THE PRIVACY ACT 1993

Please read this statement/authorisation notice in full

Have you ever had or are there now any attachments or legal proceeding against you, or any action for payment default?

    

I/We 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/We 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.

Applicant tick here - I have read and accept the terms and conditions within this informative statement/authorisation (if you do not tick this box we will not be able to process your application)


Click the "Send" button to send this application form