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Personal Loans Application Form
To find out whether a personal loan is right for you please complete the form below.
Step
1
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7
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Introduction
Contact Details
Region *
Choose your region
Northland
Auckland
Coromandel
Tauranga
Whakatane
Opotiki
Rotorua
Taupo
Waikato
Central Plateau
East Coast
Hawkes Bay
Taranaki
Wanganui – Rangitikei
Manawatu - Palmerston North
Wairarapa
Wellington
Nelson
Marlborough
North Canterbury
Christchurch
South Canterbury
West Coast
Otago - Dunedin
Otago - Alexandra & Cromwell
Queenstown & Wanaka
Southland
First Name(s) *
Surname *
Date of Birth
(dd/mm/yyyy)
Phone *
Email *
Amount Required *
Application Type:
Choose Type
Individual
Joint Application
Tell us about why you are making this application?
I have used a Mike Pero broker before
Previous Mike Pero broker
Privacy Act 1993 I/We a) declare the above information is true and correct and that I am/we are over the age of 18 years and I am/we are not an undischarged bankrupt/s; b) authorise you (Mike Pero Mortgages Limited) to send this application to any third party (the FINANCE COMPANY): and c) agree the FINANCE COMPANY may collect from credit reporting agencies, credit providers, my/our employers/s, accountant/s, or other named person/s or relative/s, such personal, financial and commercial information and references about me/us as is necessary for the purposes of considering this application. And I/we agree that you may produce this authority to such parties for the purposes of collecting such information. d) I/we agree to meet the cost of an independent valuation of the security to support this application such valuation to be obtained by you in consequence of this applicant. My/our solicitor/agent is authorised to accept any notification on my/our behalf. e) I/we declare that the above information is true and correct in every particular and it is upon this basis that I/we make this application. I/We acknowledge that if the FINANCE COMPANY provides this finance the FINANCE COMPANY: a) will keep the personal information during this period the finance is provided and will retain and use this information unless advised in writing by me/us after repayments of all credit provided by the FINANCE COMPANY: b) may collect and monitor personal information about me/us as is necessary for the administration and protection of such credit: and c) may provide any of the personal information to a third party employed by the FINANCE COMPANY to assist in enforcement of any agreement between us. d) I/We request the FINANCE COMPANY or any related finance company to send me/us details of other products and services from time to time. Where the personal information may readily be retrieved, I/WE shall have access to it and the right to request correction. Provision of Additional Services I authorise the FINANCE COMPANY to disclose personal information about me to a credit agency for the purposes of compiling a credit report, creating a credit profile, merchandising, market research and offering additional services including newsletters from Mike Pero Mortgages Limited or the offer of additional credit facilities. The information that may be disclosed includes: name, address and telephone number; the loan amount of any facility; any debits made; the frequency and amounts of payments made including details of overdue payments. I understand that I have the right to access and request correction of my personal information held by the credit reporting agency.
I accept the above privacy statement and authorisations.
I give permission for my contact details to be used for sending me information about Mike Pero products and services that may be of interest to me.
Please enter code
Applicant 1
First Name(s)
Surname
Date of Birth
(dd/mm/yyyy)
NZ Residency Held?
Yes
No
Marital Status
Married
Defacto
Single
Drivers Licence Number
Number of Dependents
Choose dependents
0
1
2
3
4
5
6
7
8
9
10+
Current Residential Address
Time at address
Years
Months
If less than 3 years what was your previous address, include years/months at this address
Previous Address
Are you currently?
Renting
Boarding
Living in own home
Other
Home Phone
Work Phone
Mobile Phone
Email
Employment
Main Source of Income
Salary/Wages
Self Employed
Other
Occupation
Employer/Business Name
Type of Business
Term of Employment
Years
Months
If less than 3 years, what was your previous employment, include years/months at this employment
Previous Employment
Applicant 2
First Name(s)
Surname
Date of Birth
(dd/mm/yyyy)
NZ Residency Held?
Yes
No
Marital Status
Married
Defacto
Single
Number of Dependents
Choose dependents
0
1
2
3
4
5
6
7
8
9
10+
Current Residential Address
Time at address
Years
Months
If less than 3 years what was your previous address, include years/months at this address
Previous Address
Are you currently?
Renting
Boarding
Living in own home
Other
Home Phone
Work Phone
Mobile Phone
Email
Employment
Main Source of Income
Salary/Wages
Self Employed
Other
Occupation
Employer/Business Name
Type of Business
Term of Employment
Years
Months
If less than 3 years, what was your previous employment, include years/months at this employment
Previous Employment
Monthly Income
At date of application
Salary/Wages
$
Business/Employed
$
Benefits (income support)
$
Interest/Dividends
$
Other
$
Do you have rental properties?
Yes
No
Rental Income 1
Address
Type
Existing
Proposed
Per Month
$
Rental Income 2
Address
Type
Existing
Proposed
Per Month
$
Rental Income 3
Address
Type
Existing
Proposed
Per Month
$
Total Income
$
Statement of Assets
Property
1. Address/Value
$
2. Address/Value
$
3. Address/Value
$
Vehicles
1. Make/Model/Registration
2. Make/Model/Registration
3. Make/Model/Registration
Other Assets
1. Other
$
2. Other
$
3. Other
$
Total Assets
$
Statement of Liabilities
Mortgages
1. Bank/Liability/Payment
$
$
2. Bank/Liability/Payment
$
$
3. Bank/Liability/Payment
$
$
Personal Loan
1. From/Liability/Payment
$
$
2. From/Liability/Payment
$
$
Hire Purchases
1. From/Liability/Payment
$
$
2. From/Liability/Payment
$
$
Credit/Store/Charge Cards
1. From/Limit/Liability
$
$
2. From/Limit/Liability
$
$
3. From/Limit/Liability
$
$
Student Loans
$
Other Liabilities
$
Total Liabilities
$
Total (Per Total Assests)
$
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