Application Form (3-5 mins)

For assistance please call us on 0800 21 21 21.

Items marked with an asterisk (*) are mandatory. Entering as much information as possible may save time later on in the application process.

Applicant Details
NZ resident:	*YesNo
Title: (Mr, Mrs, Ms, Etc)	*
First name:	*
Middle name:
Last name:	*
	Day	Month	Year
Date of birth:	*
Marital status:	*
Maiden name?
If you are married or in a defacto relationship, your partner must apply also (as co-borrower) and sign on any contract documentation.

Contact Details	Best Contact?
Home phone:
Work phone:
Mobile phone:
Email address:	*
Confirm Email:	*

Current Address
Street number and name:	*
Suburb:	*
City:	*
How long living there?	*Years Months

Previous Address
Street number and name:
Suburb:
City:
How long lived there?	Years Months

Employment Details
Employment situation:	*Employed Beneficiary
Occupation:
Employer:
How long worked there?	Years Months
Take home pay (after tax):	*$
Do you get paid?	* Weekly Fortnightly Monthly

Any other income?	If YES, please complete below.
Other Income (After tax):	$
Do you get paid?	Weekly Fortnightly Monthly

Other Contact
Parents names:
Parents address:
Parents phone:

Nearest relative:
Relative address:
Relative phone:
Relationship to you:
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COBORROWER DETAILS (if applicable)
NZ resident:	Yes No
Title: (Mr, Mrs, Ms, Etc)
First name:
Middle name:
Last name:
	Day	Month	Year
Date of birth:
Marital status:
Maiden name?

Contact Details
Home phone:	Best?
Work phone:
Mobile phone:
Email address:
Confirm email:

Employment Details
Employment situation:	Employed Beneficiary
Occupation:
Employer:
How long worked there?	Years Months
Take home pay (after tax):	$
Do you get paid?	Weekly Fortnightly Monthly

Any other income?	If YES, please complete below.
Other Income (after tax):	$
Do you get paid?	Weekly Fortnightly Monthly
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LOAN DETAILS
Loan type:	*
Loan amount:	*$
Loan purpose:	*
	Day	Month	Year
Required by:	*
Amount of repayments:	*$
Frequency of repayments:	* Weekly Fortnightly Monthly
	Day	Month	Year
First repayment on:	*
Repayment by:	* Manual Automatic Payment
Have you had a loan before?	No Yes, With?
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*SECURITY DETAILS:
Real Finance Limited requires that most loans are secured. Security falls into the following catergories, and can be combined: Household Chattels - An agent of Real Finance Limited MUST sight goods. Vehicle - You must be the owner, and give registration details.. Property - Provide ONE of the following: Address, Certificate of title, valuation number, and a description of the property. Unsecured - Evidence of good credit will be asked for. Other - Please specify
	Enter Specifics Here
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HOW DID YOU FIND US?	*
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MAILING LIST
I/We am/are happy to receive information from Real Finance Limited about any specials or deals that they may have, from time to time. Real Finance Limited keeps all information strictly confidential and will not hire or sell any of the information discussed in this Application Form regardless of whether the above is ticked or not.
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DISCLAIMER: APPLICATION CONDITIONS
Under the terms of the Privacy Act (1 July 1993) I/We authorise any person or company to provide Real Finance Limited or their agents with such information that they may require in response to credit enquiries. I/We authorise Real Finance Limited or their agents to furnish to any third party details of this application and any subsequent dealings that I/We may have as a result of this application being actioned. I/We agree to you arranging Credit Checks, and/or budget analysis and/or chattel valuation, the cost of which will be added to my/our loan. If this loan application is declined this form shall remain with and the property of the issuer. * I/We declare that to the best of my/our knowledge, the above information that I/we have provided is true and correct and, I/We understand, accept and agree to the application conditions.

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QUICK LINKS

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