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Loan Details

I am looking for a vehicle up to:

I have a deposit of:

I would like a term of: months

Applicant Details

Applicant Surname:

Applicant First Names:

Date of Birth:

/ /

Marital Status:

Spouse Surname:

Spouse Date of Birth:

/ /

Resident Status:

No. of Dependants:

Spouse First Names:

Drivers Licence

Card No. (5a):

Version No. (5b):

Drivers Licence Type: Full Restricted Learners

Spouse's Drivers License

Spouse Card No. (5a):

Version No. (5b):

Drivers Licence Type: Full Restricted Learners

Contact Details

Phone No. Private:

( )

Email:

Mobile:

( )

Address Details

Accomodation:

Details (if other):

Current Address:

Suburb:

City:

Post Code:

Time at Address (years):

Employment Details

Employer Name:

Employer Address:

Previous Employer:

Spouse Employer:

Spouse Employer Address:

Occupation:

Employment Length (years):

Previous Occupation:

Spouse Occupation:

Spouse Employment Length (years):

Alternative Contacts

Nearest Relative:

Address:

Additional Contact:

Address:

Relationship:

Phone No.:

( )

Relationship:

Phone No.:

( )

Account References (HP/Credit Card etc.)

First Account Reference:

Bank:

Second Account Reference:

Account No.:

Financial Details

Assets (please note all jointly owned assets)

Home (joint / FH):

Furnishings:

Bank:

Car:

Investments:

Other:

Liabilities

Mortgages:

HP/Credit Accounts:

Bank O/D:

Other Creditors/Loans:

TOTAL:

NET WORTH:

Income (weekly)

Applicant Average Take Home Pay:

Spouse Take Home Pay:

Other Sources of Income:

Rental / Boarder:

Investment Income:

Superannuation:

Other - Specify:

Reason:

Expenses (weekly)

Accomodation:

Rent:

Mortgage:

Loan Payments:

HP / Consumer:

Credit Card:

Bank:

Personal:

Household:

Rates:

Power:

Home Insurance:

Phone / WIFI:

Maintenance:

Vehicle:

Fuel:

Vehicle Insurance:

Repairs / WOF:

Groceries / Supermarket:

Cell phone:

Clothing:

Afterpay/Laybuy/Humm etc:

Tithing:

Health And/Or Life Insurance:

Other Expenses:

TOTAL:

Is this person a politically exposed person? Yes No

PRIVACY ACT 1993 ACKNOWLEDGEMENT AND AUTHORISATION FOR COLLECTION, USE AND DISCLOSURE OF INFORMATION

I/We authorise any person or company including but not limited to Equifax NZ and other credit agencies to provide you with such information as you may require in response to your credit enquiries, including but not limited to information obtained from the Personal Property Securities Register in respect of the motor vehicle offered as security for this loan .

I/We authorise you to furnish to any third party, including Equifax NZ and other credit agencies, details of this application including Drivers Licence details, which I have voluntarily provided, and any dealings that I/We may have with you as a result of this application being actioned by you.

I/We authorise Falcon Advances Limited to access my/our drivers licence record using the NZTA’s Driver Check service and I/We confirm that the applicant/s will be the sole registered owner/s of the above vehicle.

I/We authorise Falcon Advances Limited to contact Equifax NZ , Credit providers, Finance Companies, my Employer, Landlord, Accountant, Bank, Solicitor or any other source , including Government agencies , to obtain, check & exchange information for the protection & administration of any loan arising out of this application.

To help the government fight the funding of terrorism and money laundering activities, law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver’s licence or other identifying documents.

(Enter the word ACCEPT)

PERSONAL PROPERTY SECURITIES ACT 1999 VERIFICATION STATEMENT WAIVER

The customer waives/does not waive [Delete one. If no deletion, to be read as “waives”] the need for Falcon Advances Limited to forward a copy of any verification statement in respect of any financing statement or financing change statement registered under the Personal Property Act 1999 “PPSA” by Falcon Advances Limited in connection with any agreement.

THE INFORMATION YOU HAVE PROVIDED WILL ALLOW US TO QUICKLY ASSESS THE LIKELIHOOD OF YOUR APPLICATION BEING SUCCESSFUL

IN ORDER TO FULFILL OUR OBLIGATIONS UNDER THE RESPONSIBLE LENDING CODE, BEFORE FINAL APPROVAL WE MAY NEED FURTHER FINANCIAL DETAILS FROM YOU

THANK-YOU FOR YOUR UNDERSTANDING