Credit Application Order NumberPurchase DetailsPurchase Details Purchase Price: $1.00 Deposit: $1.00 Trade In (Nett) Amount to Finance: Vehicle Make: Model: Year: 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Odo: (Kilometers) Dealer Dealer Name: Sales Person: Phone Number: Mobile No: Personal Information First Names: Marital Status: First Name: Date of Birth Main Applicant Drivers Licence No: Licence Type: Leaner Restricted Full Email Address: Surname: Number of Dependants: 0 1 2 3 4 5 6 7 8 9 10 Surname: Date of Birth: Joint Applicant Drivers Licence No: Licence Type: Leaner Restricted Full Email Address: Home Number: Work Number: Mobile Number: Current Address: Address Status: Own the Property Tenant Boarding Previous Address: Nearest Relative: Current Address: Area Code: Years at Address: Area Code: Years at Address: Relative Contact Number: Relationship: Financial InformationAssets: Home Furnishings Bank Account Car Other TOTALTotal: Liabilities: Mortgage HP/Credit Cards Bank OD Other Loans Any Other debt TOTALTotal: Financial Income & Expenses:Income: weekly / monthly Take Home Pay * Partners Pay * Other Income * Other Income 2 TOTAL *$ / Income Expenses: weekly / monthly Mortgage / Rent * HP / Credit * Living Expenses * Loans * TOTAL *$ / Income Debt Service Ratio:$ Employment Information: Present Employer Years with Current Employer: Current work Address: Joint Applicant Employer: Years with Current Employer: Current work Address: Previous Employer: Years with Previous Employer: Occupation & Title: Joint Applicant Previous Employer: Years with Previous Employer: Occupation & Title: Required Documentation: Application Form Filled out and signed Copy Drivers License (overseas or international driver’s license is acceptable) * Additional photo ID. (copy of passport, firearms license, 18+ card), this is required to satisfy the new AML government compliance requirements * Proof of Address. A copy of a utilities bill or account not more than 4 weeks old. This can also be a payslip or bank statement as long as your full address is shown on the payslip or statement. * Copy of latest payslip (if you are receiving a benefit then please supply a letter of confirmation from WINZ) * Copies of 2 months of your latest bank statements. * If you have a Student, Work, or Visitors Visa or have Permanent Residence, then please send a copy of this from your passport. Add Files Acknowledgement: Click to Acknowledge: For the purpose of this document Leafsecure Ltd might be abbreviated as LSE. Privacy Act 1993: I/We: a) warrant that the information provided in this application is true and correct; b) authorise Leafsecure Ltd or any of its partners ("Heartland Bank") to contact my/our employer, any credit agency and any other source (each a "Source") to obtain, check and exchange (both now and in the future) information in connection with this application and any agreement that I/we may hereafter enter into with Leafsecure Ltd; c) acknowledge that my/our signature on this application shall operate as an authority to each Source to provide Leafsecure Ltdwith any information about me/us which Leafsecure Ltd may require in connection with this application or any such agreement; d) acknowledge that this application will form part of any agreement I/we may hereafter enter into with Leafsecure Ltd and that the authorisation set out above will be deemed to be incorporated into that agreement; e) authorise Leafsecure Ltd or any related company to store and process the information provided in this application to contact youwith product information, event invitations and/or customer care related material. f) You are entitled, under the provisions of the Privacy Act 1993, to: (a) have access to personal information held by Leafsecure Ltd about you; and (b) request correction of any personal information held by Leafsecure Ltd about you; in either case in accordance with the provisions of that Act Privacy Policy * Date: Signature Main Applicant: Upload Signature Sinature Joint Applicant: Upload Signature
