First Credit Union Loan Application

What is your title? *	Mr Mrs Miss Ms Other
First Names *
Last Names *
Have you ever gone by any other name? (maiden name or other)
Other Names
What is your home address?*
Postcode*	Find your postcode
Email
What is your date of birth * (dd/mm/yyyy)
How many dependent children do you have? *	None One Two Three Four Five Six Seven Eight Nine Ten
Child 1 Age *
Child 2 Age *
Child 3 Age *
Child 4 Age *
Child 5 Age *
Child 6 Age *
Child 7 Age *
Child 8 Age *
Child 9 Age *
Child 10 Age *
What is the best number to contact you on during the day? *
Please provide contact details for one relative or friend in New Zealand NOT living with you
Their Name *
Their Address *
Their Home Phone *
Their Mobile
Relationship to you *
Are you employed? *	Yes, full time Yes, part time/casual No, unemployed
Employers Name * Employers Phone Number * Employers Address * Length of time employed *
What is your occupation? *
Are you a permanent resident/citizen of New Zealand? *	Yes No
Do you have a joint applicant? *	Yes No
What is their title? * Mr Mrs Miss Ms Other First Names * Last Names * What is their date of birth? * (dd/mm/yyyy)
Have you or your joint applicant been declared bankrupt or gone through the No Asset Procedure? *	Yes No
Do you or your joint applicant own a vehicle? *	Yes No
What is the Registration number? * What is the value of the car? $
Do you have a current drivers license? *	Yes No
Drivers License type? *	Learners Restricted Full
Drivers licence number *
Drivers licence version number *
How much would you like to borrow? *	$
What is the purpose of the loan? *	Debt Consolidation Buy Vehicle Car Repairs Holiday Other
Please enter the loan purpose*
What is your net income after tax? *	$ Weekly Fortnightly Monthly
How is your income spent? *   Rent/Board/Mortgage * $ Spending/Living costs * $ Savings * $ Other Debt * $ Other Costs (Insurance,child support etc) * $ Total $ What do you owe? *   Mortgage * $ Personal Loans * $ Overdraft/s * $ Other (Store Cards,HP's,Credit Cards etc) * $     Total $
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