Phone: 09 820 2484 Free Phone: 0800 744 227 Email: firstname.lastname@example.org
09 820 2484
(All fields MUST be completed before you send the Application)
How long have you lived here
You must be able to visit one of our Auckland branches to sign your loan document
INFORMATION STATEMENT/AUTHORISATION PURSUANT TO THE PRIVACY ACT 1993
Please read this statement/authorisation notice in full
Have you ever had or are there now any attachments or legal proceeding against you, or any action for payment default?
I/We apply for a loan and certify that the particulars above and overleaf are true and correct and that I am over the age of 18 years and am not an undischarged bankrupt. Pursuant to the Privacy Act 1993 I authorise any finance company to contact any credit reporting agencies, credit providers, my employer(s), accountant(s), or any other source, to obtain, check and exchange (both now and in the future) such personal, financial and commercial information and references about me/us as is necessary for the purposes of considering this application, the protection and administration of any loan arising out of this application, and to assist in the enforcement of any agreement between me/us and any finance company. I agree that you may produce this authority to such parties for the purposes of collecting such information. Under the provisions of the Privacy Act 1993, you are entitled to have access and request correction to personal information held about you.
I/We agree that the information in connection with this finance application may be transmitted via facsimile and/or electronic mail, and I acknowledge that there may be some security risks associated with the transmission.
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