APPLICATION FOR CREDIT

PERSONAL INFORMATION
Full Name Name of Spouse
Phone Number Home Work Mobile
Date of Birth Date of Birth (Spouse) License No.
Marital Status No. of Dependants
Residential Address Years
Postal Address
Residence (Please Tick)
Previous Address Years
Occupation Employer Years
Previous Employer
RELATIVE/NEXT OF KIN
Name Address
Phone Number Relationship

REFERENCES
CREDIT: (Hire Purchase, Credit Accounts or other loans)
Company Company
Monthly Payment Monthly Payment
   

FINANCIAL INFORMATION
INCOME: ASSETS:
Monthly Take Home Pay Property/Home
Partners Take Home Pay Cash/Bank
Other Income Vehicles
TOTAL (A) Home Contents
EXPENSES: Investments
Mortgage/Rent Other:
HP/Loans/Credit Cards TOTAL (C)
Rates/Phone/Power LIABILITIES:
Vehicle Expenses Mortgage
Insurances: Home/Life/Car Credit Cards
Other HP/Credit Cards
TOTAL (B) Bank OD/Loans
    Other Creditors
NET SURPLUS (A)-(B) TOTAL (D)
    NET WORTH (C)-(D)

DETAILS OF LOAN REQUESTED
Amount Reason
Security Offered
Term Months: Date of Draw Down
Loan to include


The purchaser acknowledges and authorizes Finance & Investments to collect and hold personal information to process a finance application made by the purchaser who is aware the personal information may be disclosed to credit reporting agencies, Valuers, Solicitors, Insurance companies or agents, and any other person necessary to process the application. The Purchaser is aware that if all relevant personal information is not supplied then Finance & Investments is under no obligation to consider the application. purchaser acknowledges they are aware they have the rights of access to and correction of personal information held by Finance & Investments. The purchaser authorizes Finance & Investments to disclose personal information relating to the purchaser to any credit reporting agency, Insurance Agent or Company, Valuer, Solicitor or any other person or company requesting the same.
Signed Date

and fax it to us on (03) 548 9600