Amount required
(minimum loan amounts apply in some locations)
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$*
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Reason for loan
(e.g. car loan, debt consolidation, personal)
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*
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Applicant Details
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Title (Mr,Mrs,Ms,etc)
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*
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First name
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*
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Middle name(s)
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Surname
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*
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Other name
(e.g Maiden name, Married name)
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Marital status
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*
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Date of birth
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Day Month
Year
*
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How many dependant family do you support financially?
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*
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Are you a NZ resident?
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YesNo
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Contact Details
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Home phone
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Work phone
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Mobile phone
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Email
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*
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Current Address
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Street address
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*
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Suburb
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*
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City
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*
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How long have you lived there?
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*
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Do you
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Board Rent Rent to own Own *
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How much do you pay?
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$ Week Fortnight
Month *
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Current Employment
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Current employment
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*
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Employer
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*
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How long have you worked there?
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*
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Employment type
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*
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Take home pay after tax
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$ Week
Fortnight Month *
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Do you receive any extra income? Please complete boxes below if YES
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Take home pay after tax
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$ Week Fortnight
Month
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Where do you receive this from?
(e.g. part-time job, rental income, family assistance, etc)
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Co-borrower Details (if applicable)
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Title (Mr,Mrs,Ms,etc)
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First name
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Middle name(s)
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Surname
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Other name
(e.g. Maiden name, Married name)
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Marital status
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Date of birth
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Day Month
Year
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How many dependant family do you support financially?
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Are you a NZ resident?
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YesNo
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Co-borrower Contact Details
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Home phone
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Work phone
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Home phone
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Email
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How did you hear about Payplan?
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Additional information and comments
(Please include any additional
information you feel is important)
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-
I/We understand that all personal information ("personal
information") Payplan Debt Management ("you") holds
about me, whether now or in the future, will be used to assess my credit
worthiness and financial position (from time to time), and to process
and assess any application for credit I have made with you.
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I/We authorise:
-
you to make enquiries about me, disclose personal information to any
third party (e.g. disclosing default information to Baycorp Advantage)
and/or obtain information about me that you consider necessary from such
third party for the purposes set out in paragraph 1 or to collect any
outstanding debt from me, or for any other enforcement by you. In this
regard I authorise such third party to provide to you information about
me that you consider necessary for such purposes;
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you to disclose information about me (where required) to your insurers,
potential assignees, credit rating and credit reporting agencies such as
Baycorp Advantage.
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you to use any of the information about me for the purposes of informing
me about your other products and services.
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I/We understand that I have the right to access and correct personal
information held by you by contacting you.
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I/We understand that all information you provide to Baycorp Advantage
(including my/ our default information) will be held by Baycorp for its
credit reporting service and Baycorp may give such information to its
customers who use its service. I/We also understand that I/We may access
and correct the information held by Baycorp by writing to Baycorp at
Private Bag 92156, Victoria Street, Auckland
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I/We declare that the information I have provided to you in this
application is correct and complete and I agree to immediately advise
you of any change to any information contained in this application.
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I/We understand that you reserve the right to decline this application.
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I/We agree that information in connection with this application for
finance may be transmitted via facsimile and/or electronic mail.
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I/We acknowledge that there are security risks associated with the
electronic transmission of information.
THE ABOVE INFORMATION IS TRUE AND CORRECT
* I have read and
accept these terms and conditions
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