Vehicle Finance Single Applicant Form Vehicle Finance Vehicle Finance Application Form Step 1 of 19 5% Title MrMrsMsMissDrProfRev First name* Middle name Surname* Gender* Female Male Date of Birth* Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Marital Status* SingleMarriedDivorcedWidowedSeparatedPartner – De facto Number of Dependents 012345678910 Licence Number Home Contact Number* Mobile Contact Number* Work Contact Number Email* Enter Email Confirm Email Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Time at address Residential Status* RentingOwner With MortgageOwn OutrightWith ParentsBoardingOther Mortgagor / Landlord / Real Estate Agent Occupation* Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOther Employment* Employed Full-TimeEmployed Part-TimeSelf-employedNot employedbut looking for workNot employed and not looking for workHomemakerRetiredStudentPrefer Not to Answer Employer Employer Contact Name Employer Contact Number Time at Employer Less than a month1-6 months1-3 yearsOver 3 Years Previous Employment Type* Employed Full-TimeEmployed Part-TimeSelf-employedNot employedbut looking for workNot employed and not looking for workHomemakerRetiredStudentPrefer Not to Answer Previous Occupation* Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOther Previous Employer Previous Employer Contact Name Previous Employer Contact Number Previous Time at Employer Less than a month1-6 months1-3 yearsOver 3 Years Monthly net income from employment* Other Income* Monthly Mortgage / Rent payments* If Zero Please enter Zero Living Expenses* Purpose for loan* car loan, caravan, motorbike etc Amount required* Assets Home Value Description Value Investment Properties Description Value Motor Vehicles Description Value Superannuation Description Value Savings Description Value Home Contents Description Value Other Description Value Asset types include: Property, Motor Vehicles, Savings, Superannuation, Home Contents. Other Liabilities Home Loan Debt Limit Approximate Balance Monthly Repayments Car loan Debt Limit Approximate Balance Monthly Repayments Personal Loan Debt Limit Approximate Balance Monthly Repayments Credit Cards Debt Limit Approximate Balance Monthly Repayments Other Debt Limit Approximate Balance Monthly Repayments Liability types include: Commercial Bill, Credit Card, HECS, Hire Purchase, Leases, Line of Credit, Loan as Guarantor, Maintenance, Mortgage Loan, Other Loan, Outstanding Tax, Overdraft, Personal Loan, Store Card, Term Loans What is the purpose of the credit you are considering?(eg – Purchase motor vehicle, debt consolidation, refinance)* Is there any other relevant information we should know?* How long do you expect to remain in the credit contract? (eg – Do you expect to sell the vehicle in a certain time)* What kind of Balloon Payment or Residual Value are you considering, if any?* Have you had any judgements, defaults or legal proceedings against you in respect of Utilities or credit contracts in the past? If YES please provide details* Are all current credit commitments up to date? If NO please provide details of how you intend to make all payments up to date* How would you rate your current job security from 1 to 10? (the higher the number, the more secure you feel)* 1 2 3 4 5 6 7 8 9 10 Are there any lenders that you do not wish to deal with?* Do you have any preference as to the type of lender that you wish to deal with?* Do you anticipate that your INCOME will change materially in the next 6-12 months?* Do you anticipate that your EXPENSES will change materially in the next 6-12 months?* Do you have adequate insurance to meet your repayments should you not be able to work? (such as life insurance, loan protection insurance, income protection)* Yes No Not Sure If answered NO or DON’T KNOW would you like one of our associates to contact you regarding insurance?* No Yes Do you have adequate motor insurance to meet your loan balance should the vehicle be written off?* Yes No Not Sure If answered NO or DON’T KNOW would you like one of our associates to contact you regarding insurance?* Yes No {all_fields} Comments This field is for validation purposes and should be left unchanged.
