Online Application for Finance Please fill in as many fields as you can 1. Your Personal Details First Name* Surname* Email Address* Contact Phone* Mobile Phone Work Phone Date of Birth Do you have a New Zealand Residency?* No Yes Home Address Current Tennancy Own Home Rent Board Live with Family House in Trust How long have you lived there? Previous Address Previous Tennancy Own Home Rent Board Live with Family House in Trust How many years have you lived there? Marital Status Married Defacto Divorced Separated Single Widowed Number of Dependents Drivers Licence Number Type of License Full Restricted Learners 2. Employment Details Present Employer How long with present employer? Present Wages or Salary Full Time Part Time Permanent Casual Present Employers address Present Employers phone Present Employer contact person Previous Employer How long with previous employer? Previous Wages or Salary Full Time Part Time Permanent Casual Previous Employers address Previous Employers phone Previous Employer contact person 3. References Nearest Relative (not living with you) Nearest Relative relationship Nearest Relative phone Nearest Relative address Personal Contact Personal contact phone Personal contact address 4. Account References Please list all previous or existing loans, credit cards, etc. Previous finance company Oxford MTF G.E. Geneva U.D.C. None Other Are these accounts still current?* No Yes If yes, please specify 5. Holden Kapiti How did you hear about Holden Kapiti? Existing Client Referral Newspaper Radio Internet Search Other 6. Purchase Details Purchase price Other Costs Total Cost Purpose Applicants Contribution Trade in This Loan Amount Total Funding Term of loan 7. Trade in Details Are you going to trade in your old vehicle as part of this purchase?* No Yes Year of manufacture Make Model Registration Expiry Value of trade Net trade in value Is an insurance settlement on a previous vehicle part of this purchase?* No Yes Insurance Company Amount of settlement Settlement made out to 8. Finance Details Average Monthly Expenditure(for fields that don't apply put 'zero') Rent/Mortgages Car loan expenditure Total Hire Purchases Other loan expenditure This loan expenditure Total expenditure Assets(for fields that don't apply put 'zero') House Furnishings Investments/bank Car Other Assets Total Assets Average Monthly Income Applicant Other Total Liabilities(for fields that don't apply put 'zero') Mortgage Outstanding Store Cards Credit Cards Car loan liabilities Bank loan/overdraft Other liabilities Total liabilities Bank account details(for this loan) Bank Branch Account Number 9. Co-borrower Are you applying for this loan with a co-borrower?* No Yes Your co-borrower's name 10. Privacy Act Have you ever had or are there now any attachments or legal proceeding against you, or any action for payment default?* No Yes If yes, state details I/We certify that the particulars above are true and correct and that I am over the ago of 18 years and am not an undischarged bankrupt. Pursuant to the Privacy Act 1993 I/We authorize Oxford Finance to contact any credit reporting agencies, credit providers, my/our 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 purpose of considering this application, or for any future application, the protection or administration of any loan rising out of this application and to assist in the enforcement of any agreement between me/us and any finance company. I/We 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 consideration to personal information held against you. Application Date* Full name (of applicant)*
