Loan Application Form
How much do you want to borrow?
*
How much would you like to borrow?
$
Desired Loan Term in Years
*
Repayment Frequency
Please Select
Weekly
Fortnightly
Monthly
What is your loan for?
*
Car or Motorbike
Boat or Jetski
Truck
Caravan
Home Improvement
Wedding or Event
Debt Consolidation
Travel
Other
If purchasing a vehicle please enter Registration or VIN number
Are you buying from a Dealership or is this a Private sale?
Drivers Licence
Drivers Licence Number
Version Number
License Type
Please Select
Learners
Restricted
Full
Overseas
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Contact Information
Your Personal Details
Name
*
First Name
Middle Name
Last Name
Residency Status
*
Please Select
NZ Citizen
NZ Resident
NZ Work Visa
Other
Date of Birth
*
Please select a day
1
2
3
4
5
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7
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9
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30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
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1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Marital Status:
*
Single
De Facto
Married
Separated
Do you have any dependents?
if no dependents please enter ''0''
Mobile Number
-
Landline
Format: (00) 000-0000.
E-mail
*
example@example.com
Address
Street Address
Street Address Line 2
Suburb
Post Code
City
How long have you lived in your given address?
*
0-1 Year
1-2 Years
3-4 Years
5+ Years
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Financial Information
Income and Employment
Employment Status
*
Please Select
Full Time (Permanent)
Part Time (Permanent)
Self Employed
Fixed Term Contract
Beneficiary
Other
Occupation
Name of Employer
Number of years working at current employer
0-1 Year
1-2 Years
3-4 Years
5+ Years
Gross Monthly Income
Any Additional Income
Gross Monthly Benefit or Tax Credits
Partners Income
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Financial Information
Expenses - Monthly amount
Monthly Rent or Mortgage Repayments
Groceries / Food
Fixed Living expenses
Existing Vehicle Finance
Monthly Insurance Costs
School Fees
Vehicle Costs (Fuel & Insurance)
Subscriptions
Other Expenses (Please Describe)
Monthly Cost of Other Expenses
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Assets Liabilities
Value Balance owing
Balance in Bank Account / Savings
Overdraft
Property Value
Mortgage Balance
Personal Effects
Mortgage Balance
KiwiSaver Balance
Other Liabilities
Value of any Vehicles Owned
Vehicle Finance
Name of Credit Provider
Credit card or Personal Loan Balance
Name of Credit Provider
Credit card or Personal Loan Balance
Other Expenses (Please Describe)
Monthly cost of Other Expenses
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Confirmations and Disclosures
Are you aware of any upcoming changes to your current circumstances or financial situation that could affect your ability to make the loan repayments over the term of the finance contract?
*
Please Select
Yes
No
I confirm that all information provided in this application is true and complete, and that I have disclosed all relevant expenses that may impact the approval of this finance application.
*
Please Select
Yes
No
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Notes - Anything else you would like to let us know
Consent
I authorize Bloom Financial Group Ltd and any lending or credit reporting agencies to collect personal and credit information about me from my employer, credit bureaus, or any individuals or entities with whom I have financial dealings, as well as from any references I have provided. This information, along with what I provide in my application, may be used in connection with this application and any future relationships we may have. Additionally, my personal and credit information may be shared with other lenders, credit bureaus, or credit reporting agencies as needed.
YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission and that I am not an undischarged bankrupt. By submitting your application, you agree to our privacy policy - https://bloomfg.co.nz/privacy-policy
YES
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