Personal Loan Application Form

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Member Number
Title
First Names
Last Name
Date of Birth (DD/MM/YYYY)
Gender
Address
Postcode
Living Arrangement
Home Phone
Work Phone
Mobile Phone
Fax
Email Address
Referee Name: Note: This person must not be living with you and will be contacted for verfication prior to your loan being approved.
Referee Address
Referee Home Phone
Referee Mobile Phone
Relationship to you
Licence Type
Driver License Number
Version Number
Number of Dependants
Have you been Bankrupt/NAP/SIO
Are you an NZ Resident
Employed
Employers Name
Employers Address
Length of Employment
Add a Joint Applicant
Title
First Names
Last Name
Date of Birth (DD/MM/YYYY)
Gender
Address
Postcode
Home Phone
Work Phone
Mobile Phone
Email Address
Licence Type
Driver License Number
Version Number
Employed
Employers Name
Employers Address
Length of Employment
Number of Dependants
Have you been Bankrupt/NAP/SIO
Are you an NZ Resident
Total Weekly Net Income
Total Weekly Expenses
Loan Amount
Repayment Amount
Select a Repayment Frequency
Loan Purpose

Vehicle to Use as Security
Vehicle Registration Number
Vehicle Make
Vehicle Model
Vehicle Year
Promo/Branch Code
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Personal Loan Application Form

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