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Application TypeIndividual ApplicationJoint Application
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Title
First Name
Middle Names
Last Name
Date of Birth12345678910111213141516171819202122232425262728293031JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember189818991900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008
GenderMaleFemale
Drivers Licence Number
Street Address
Suburb
City
Years at Current Address
Years at Previous Address
Home Phone
Mobile Phone
Fax
Email
Accommodation Type
Number of Dependants
Insurance Company (contents)
Insurance Company (vehicle)
Employment StatusBeneficiaryEmployed
Marital StatusMarriedCivil UnionDe FactoSeparatedDivorceSingleWidow
Benefit Type
Occupation
Employer
Employer's Address
Employer's Phone
Employment Duration
Previous Employer
Previous Employment Duration
Is the Joint Applicant your partner?YesNo
Middle Name
Phone Number
Relationship with you
Bank Name
Branch
Which of these Credit Cards do you have?American ExpressVisaDinerMastercardStore CardOtherNone
Have you ever been a bankrupt or had money demanded by a debt collection agency?YesNo
If yes, please supply details
Have you ever been sued?YesNo
Have you ever been convicted of a crime?YesNo
Take Home Pay
Other Income
Mortgage/Rent
Hire Purchase
Credit Cards
Other Loans
Living Costs
Mortgage Balance
Amount Required
How often would you like to pay installments?WeeklyFortnightlyMonthly
How much can you afford to pay per installment?
Security OfferedReal EstateHousehold ChattelsVehicle being purchased with loanAsset being purchased with the loanVehicle – refer to Vehicles OwnedOther
If other, please specify
Reason for loan
Make
Model
Year
Registration Number
CC Rating
Petrol or DieselPetrolDiesel
How did you hear about us?Christchurch StarThe NorthernThe SouthernThe EasternThe WesternSearch EngineYellow PagesFlyerSignageWord of Mouth
It is is a requirement of (The Money Man Ltd) that loans are to be covered by a Consumer Guarantee Plan. Please indicate whether you want the cover arranged by this company
YesNo
If yes, the following applies the cost for this cover will be added to your loan. If not, you are required to provide a copy of the I/We hereby declare that the information provided is true and correct and I agree to you arranging a budget analysis and a chattel valuation. The cost of which will be added to my loan.
I/We irrevocably authorise you to furnish to any third party details of this application and any subsequent dealings that I/We may have with you as a result of this application being actioned by you.
I acknowledge that this loan application and all supporting documentation remains the property of The Money Man Ltd and that the loan application is made on that basis and covered under The Privacy Act.
