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Fields marked with a * are mandatory.

About your purchase

What is your loan for?*

What information do you have?*

Registration*

Trade Me listing #*

Make*

Model*

Year*

About the loan

Purchase/Refinance amount*

Deposit

Loan amount

About you

Title*

First name*

Middle name

Last name*

Date of birth*

Email address*

Mobile number*

Relationship status*

No. of dependents*

I have read, understood and accept the Terms and Conditions .

I also confirm that all information I provide is correct, complete, and not misleading and that I am not an undischarged bankrupt.

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Personal details

Living situation*

Current address

Time at current address

Years

Months

Mortgage or rent payments

Previous address

Time at previous address*

Years

Months

Drivers licence*

Drivers licence number

Item 5a on your licence

Version number

Item 5b on your licence

Employment details

Employed*

Occupation*

Employer*

Employer address

Name of business*

Business address

Time at current job*

Years

Months

Net Income*

Previous employer/Name of business*

Previous employer address

Time at previous job*

Years

Months

Assets and liabilities

Value

Amount owed

Monthly repayments

Cash in bank

Value:

Cash in bank

Home

Value:

Owed:

Monthly:

Home

Vehicles

Value:

Owed:

Monthly:

Vehicles

Boat

Value:

Owed:

Monthly:

Boat

Hire purchases

Owed:

Monthly:

Hire purchases

Personal loan

Owed:

Monthly:

Personal loan

Credit card

Owed:

Monthly:

Credit card

Other

Value:

Owed:

Monthly:

Other

Additional notes

Please inform us of any other relevant information

I have read, understood and accept the Terms and Conditions .

I also confirm that all information I provide is correct, complete, and not misleading and that I am not an undischarged bankrupt.

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Amos

About your purchase

About your purchase

About your purchase

About the loan

About the loan

About the loan

About you

About you

About you

Personal details

Personal details

Personal details

Employment details

Employment details

Employment details

Assets and liabilities

Assets and liabilities

Assets and liabilities

Additional notes

Additional notes

Additional notes