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Application Form
1. a) First Name
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1. b) Last Name
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1. c) Business Name
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1. d) Registration Number
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2. Privacy Consent
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Yes
No
Do you grant permission for Blended Finance to ask for personal information, including conducting a credit and license checks, that will facilitate the loan application process while ensuring that these details remain confidential and are used solely for the purpose of assessing and processing your loan application
3. Would you like to receive life and health insurance advice from Blended Finance’s partner Global Care Advisory NZ?
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Yes
No
4. Purpose of Loan
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5. Amount of Loan
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6. Phone Number
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7. Email
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8. Date Of Birth
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9. Commercial (Business) Details: Loan Product
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Commercial loan with security
Commercial loan without security
Car Loan
Leasing
10. Marital status
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Single
Married
Divorced
Widowed
Separated
De Facto
11. No. of dependants (under 18 years)
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12. Driver’s license details : License number
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13. Driver’s license details : Version number
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14. Driver’s license details : Type of License
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Learners
Restricted
Full
Full license with condition (condition 1)
15. Driver’s license details : Issuing Country
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16. How long have you lived in NZ?
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17. If you are on Work Visa please enter your Visa expiry Date, If not type ‘NA’
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18. Residential status
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Boarding/Flatting/Sharing
Renting
Freehold Ownership
Mortgage
Living With Family
19 . Rent amount and frequency
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20. Who pays the rent?
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Myself
My spouse/partner
Shared with spouse/partner/family
21. a) Residential address
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21. b) Suburb/Town
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21. c) Postcode
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21. d) Length of Stay current address
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22 a) If less than 2 years in the current address, please provide the previous address and length of stay (In or outside New Zealand Address)
22. b) Suburb/Town
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22 c) Postcode
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22. d) Time at previous address
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23. Source of Income
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Private Employed
Public Company
Self Employed
Health/Education
Welfare/Benefit
Government Employee
Student Loan
Retirement Savings/Superannuation
Business Owner
24. Name of current company / organization and length of stay ( year and month ); example: ABC Company – 1 yr & 3 months
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25. If less than 2 years in the current company / organization , please provide the previous company / organization details ( name of previous company / organization and length of stay; example: ABC Company – 3 months )
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26. Net Income / Salary / Benefit / Allowances ( Please indicate the payment frequency whether its weekly / fortnightly / monthly /yearly. Example for net income : 2800 fortnightly)
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27. Other Income Details (if applicable)
28. Active loan/s details ( car loan / personal loan / montage ). Please indicate the payment amount , payment frequency and lender / finance company (Example: car loan – 98 per week with Sample Finance Company) You may give multiple details. You can add multiple entry.
29. Estimated living expenses
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30. Grocery ( Please provide the frequency : weekly / fortnightly / monthly
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31. Gas / Fuel ( Please provide the frequency : weekly / fortnightly / monthly
32. Car Insurance ( Please provide the frequency : weekly / fortnightly / monthly
33.Other expenses ( Please provide the frequency : weekly / fortnightly / monthly
34. Type of loan required
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Car Loan
Motorbike Loan
Caravan Loan
Boat/Jet ski Loan
Tractor/Heavy Equipment Loan
Personal Loan
Debt Consolidation
35. a) Next of kin
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35. b) Contact Number
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35. c) Relationship
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36. a) The Blended Finance, creditor, and motor vehicle deal who talked to you about this application: (a) has explained the type of product and payments required if this application is successful and those suit my objectives: (b) has provided me the detailed terms of the agreement
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I Agree
I Don’t Agree
36. b) If the application is approved, you authorize Blended Finance, creditor, and motor vehicle dealer (a) to send any disclosure statement required to be provided to the email address specified in this application; and (b) to send any other communication required by electronic mail to the address set out in this application and to any other address the borrower directs Blended Finance, creditor, and motor vehicle dealer to use, and (c) at any time, to contact and provide any information about any agreement you have will enter with Blended Finance, creditor, and motor vehicle dealer including information about defaults under that agreement, to any person you have listed on the application form as a contact person or next of kin.
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I Agree
I Don’t Agree
36. c) If your application is approved and you enter into a loan agreement with creditors, we, the Blended Finance will store your personal information on the terms set out in the loan agreement you enter into with the creditor. If your application is not approved or you decide not to proceed, Blended Finance and creditors will not retain any personal information except as required by law.
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I Agree
I Don’t Agree
36. d) You agree that Blended Finance and creditors may provide you with information about products and services related to finance in electronic form to the email address in this application
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I Agree
I Don’t Agree
36. e) Creditors make all lending decisions. Motor vehicle dealers and Blended Finance are agents of creditors for the purpose of receiving and providing information between creditors and you. If this application is successful and you enter a loan agreement, Motor vehicle dealers and Blended Finance may receive commission from the creditor
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I Agree
I Don’t Agree
36. f) I/We authorise Blended Finance, the creditors and all related companies (as defined in the Companies Act 1993) to use and disclose the personal information I/we have provided to undertake all necessary enquiries and request, collect, check and exchange information (both now and in the future), including but not limited to personal. commercial and financial information about me/us and references, from any: Credit Reporting Agency, the NZTA (NZ Transport Agency), Ministry of Justice, Ministry of lmmigration, Nz lmmigration Seryices, my employer(s), accountant, or any other source, for the purposes of assessing my creditworthiness, proyiding credit to me/us, administering and enforcing any agreement I/we subsequently may enter into with Blended Finance, creditors, and all other related companies offering me insurance, maintaining credit records with Blended Finance, creditors, and all related company and external agencies, marketing goods and services provided by Blended Finance, the creditors, and, a related company or any other supplier nominated by us. l/We alsoauthorise Blended Finance to disclose information about any application I/we make, or loan arising out of any application I/we make, to any potential assignee of this loan at any time in the future. I/We understand and agree that in order to facilitate a Credit Reporting Agency’s services Blended Finance, creditors, and all related company will disclose to such agency information about me/us for that purpose, including any updates of such information. The Credit Reporting Agency will hold that information on their systems for that purpose. Blended Finance, creditors, and all related company will also collect and disclose my/our positive credit information including monthly repayment history to credit reporters, If I/we default on my payment obligations to Blended Finance, creditors, and all related company, I/we understand that the information about that default may be given to any Credit Reporting Agency and they may give that information about my default to other Credit Reporting Agency customers.
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I Agree
I Don’t Agree
36. g) I/We also understand that: (a) Blended Finance, creditors, and all related company will meet its obligations to me under the Privacy Act 2020; (b) Such information will be held by Blended Finance, creditors, and all related companies at their business address and by other parties for the purposes described in section 7 above; (c) I have the right to access and correct personal information held about me in accordance with the Privacy Act 2020.
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I Agree
I Don’t Agree
36. h) I/We agree that Blended Finance, creditors, and all related company may use electronic communication (including email and SMS/text message) for the purpose of making disclosure to me pursuant to the Credit Contracts and Consumer Finance Act 2003, providing me/us with notices and/or changes to Blended Finance, creditors, and all related company Finance Terms and conditions and/or any other reason such as marketing of the services and products of Blended Finance and its associated group of companies. Note: If you do not wish to receive any promotional material about services and products offered by BlendedFinance and its associated group of companies, you may opt of receiving such messages by following the unsubscribe facility in any such email or text message it self, or altematively by notifying Blended Finance and its associated group in writing. If no such request to opt out is received from you, we will take it that the consent you have provided in this declaration to receive such marketing messages remains valid.
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I Agree
I Don’t Agree
37. Type Full Name
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38. Signed Date
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Message
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