Loan Application Form

Finance Application

Applicant Information
Name of Applicant*

First NameMiddle NameLast Name
Marital Status*
Home Phone *
Mobile Phone *
Work Phone
Date of Birth of Applicant*

MonthDayYear
Supporting Documents
30 Days bank statement
Proof of address
Front and back of Drivers Licence
Passport and VISA if applicable
Please upload your supporting documents here. We require:

Upload a File

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Address & Employment
Address Details*

Own HouseRentingBoardingOther
Home Address*

Street Address

Suburb

CityState / Province

Years lived at Address
Employment Details
Employment Type*
If Beneficiary: start month and start year
Please put start month and start year
If Self Employed: start month and start year
Please put start month and start year
If Full time or Part Time
Employer
Hours per week if you work part time
Employer's Address

Street Address

Suburb

CityState / Province

Postal / Zip Code
Employer's Phone Number

Contact Details
New Zealand Next of Kin Details (NB - Must not live at the same address as you)
Name (Next of Kin)*
Relationship*
Phone*
Address

Street Address

Suburb

CityState / Province

Postal / Zip Code
Another Contact's Details (eg. Friend, Workmate etc)
Name (Other Contact)*
Relationship*
Phone*
Address

Street Address

Suburb

CityState / Province

Postal / Zip Code

Financials
Income: Applicant 1
Primary Income Type*
Amount (take home pay)*
Pay Frequency*
Income: Applicant 2 / Partner Income
Partner's Primary Income Type*
Amount (take home pay)*
Pay Frequency*
Assets
Property Assets 1
Property Assets 2
Vehicle 1 Year
Make
Model
Registration No.
Current Value
Financed By
Amount Still Owing
Monthly Repayments
Vehicle 2 Year
Make
Model
Registration No.
Current Value
Financed By
Amount Still Owing
Monthly Repayments
Expense (IE. Your expenses and repayments)
Expenses Type
Amount
Paid To
Frequency
Loan Repayments
Loan Type 1
Amount
Owed To
Repayments
Frequency
Still Owing
Loan Type 2
Amount
Owed To
Repayments
Frequency
Still Owing
Loan Type 3
Amount
Owed To
Repayments
Frequency
Still Owing

Loan Details
Finance Amount*
Deposit
Trade in Amount
Vehicle Description
Comments
Preferred Term*
Frequency*
Other Information
Do you have any previous credit related issues that may need to be addressed prior to a successful application?

YesNo
If Yes. Please explain below
Are you an NZ citizen/NZ born?

YesNo
If No. Detail of your visa type
Visa Expiry Date*

DayMonthYear
Date

Apply

Submit my Application
The Privacy Act 1993

I/we authorise 4E Japan Direct* to collect, retain and use the personal information about me/us, for the purposes of:
- Assessing my/our credit worthiness;
- Attending to the financing, whether directly or indirectly, of my/our contract(s) and enforcing 4E Japan Direct’s rights thereunder;
- Marketing and/or informing me/us about the goods and services provided by 4E Japan Direct
I/we authorise 4E Japan Direct to collect from credit reporting agencies, credit providers, my/our employer(s), accountant(s), relatives, or other person(s) such personal, financial and commercial information about me/us for the said purposes.

I/we authorise 4E Japan Direct to provide this information:
- To any person for the foregoing purposes;
- to any employees and agents of 4E Japan Direct and/or any other person, in any ordinary course of business, for any of the foregoing purposes;
- To credit agencies for the purpose of maintaining proper or effective records.
I/we acknowledge that if i/we do not provide all or any part of the information requested on this application form, my/our application for finance may be declined. I/we further acknowledge that pursuant to the Privacy Act 1993, I/we have a right of access to information collected by 4E Japan Direct about me/us and to request that this information be corrected. The information will be held at the office of 4E Japan Direct,121 Wordsworth Street, Sydenham, Christchurch 8023 or the registered offices of any party nominated by 4E Japan Direct.

*4E Japan Direct and other associated third parties
To verify your acceptance of the above Privacy act statement please enter the word ACCEPT into the text box below and click the submit button.*
Type the word ACCEPT to continue
Should be Empty:

Finance Application

Supporting Documents

Address & Employment

Employment Details

Contact Details

Financials

Loan Details

Apply