Purchase Price / Value

Deposit / Equity

Loan Amount

LVR

$
Loan Type
Vehicle Personal Other

$
Borrowers
Company Trust Individual

Joint

LAQC

Guarantor

Vehicle Details Loan Purpose

Make

Model

Year

KMs

Personal Details - Applicant 1 Surname Title First Name Date of Birth NZ Resident? Smoker yes yes no no Mr Mrs Ms Miss Middle Birth Country Marital Status Age of Dependents
Married Defacto Single

Personal Details - Applicant 2 / Guarantor Surname Dr

Gender

Title First Name Date of Birth NZ Resident? Smoker

Mr

Mrs

Ms

Miss Middle

Dr

Gender

Birth Country yes yes no no Marital Status Age of Dependents

Married Defacto Single

Current Residetial Address Address Suburb Postcode City

Time there years months

Current Residetial Address Address Suburb Postcode City

Time there years months

If less than 3 years please state your previous residential address details

If less than 3 years please state your previous residential address details

Address Suburb Postcode Are you currently ... Home Phone Cell Phone Email 1 Proof of ID Drivers Licence Passport No Details Employment Main Source of Income:
Salary/Wages Self Employed Other (Please specify)

Address City
Time there Renting Boarding years Own Home months Other

Suburb Postcode Are you currently ... Home Phone Cell Phone Email 1 Proof of ID
Renting

City
Time there Boarding years Own Home months Other

Work Phone Fax No Email 2

Work Phone Fax No Email 2

Drivers 5B

B IRD No yes no

Drivers Licence Passport No Details Employment Main Source of Income:

Drivers 5B

B IRD No yes no

Do you have an adverse or poor credit rating?

Do you have an adverse or poor credit rating?

Salary/Wages Self Employed Other (Please specify)

Occupation Employer / Business Name

Type of Business Time there years months

Occupation Employer / Business Name

Type of Business

Gross Income

$
years years months months

Time there

years

months

Gross Income

$
years years months months

Business Name Business Name What is your usual pay cycle Student nuranceLoan

Employer/ Employer/

If less than 3 years - where did you work prior to that?

Business Name Business Name What is your usual pay cycle Student Loan Insurance

Employer/ Employer/

If less than 3 years - where did you work prior to that?

weekly

fortnightly

monthly
Current Repayment %

weekly

fortnightly

monthly
Current Repayment %

yes

no Current Balance

yes

no Current Balance
Income Health

Insurance
Type Provider Amount Mortgage Income Health Life Trauma Other

Insurance
Type Provider Amount Mortgage Life Trauma Other

Call Axess Finance on 0800 957 957

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