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Your Details

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Loan Details

How much do you need? *

What is the money for? *

About you

First Name *

Middle Name

Last Name *

Date of Birth *

Email Address *

Email

Confirm Email

NZ Mobile Number *

Gender *

Male
Female
I prefer not to say

Accommodation Details

Living Situation *

Own
Renting
Boarding
Living with Parents

Current Address in New Zealand *

Valid Photo ID Valid Photo ID is required to obtain a loan. If you currently do not have a valid drivers licence or passport please apply once you have received one.

Identification Type *

NZ Drivers Licence
NZ Passport
Other Passport

NZ Driver Licence number

Version number

Expiry date

NZ Passport number

Expiry date

International Passport number

Expiry date

Country of Issue

More about you

Are you a New Zealand Citizen? *

Yes
No

Note - You must live in New Zealand

What is your NZ Residency status? *

Country of Citizenship *

Country of Birth *

Visa Number *

Visa start date *

Visa expiry date *

How much do you earn each week? *

Can someone join the loan with you? *

Yes
No

We are sorry, but a higher income will be required to have a loan approved

How much do they earn weekly? *

We are sorry, but a higher income will be required to have a loan approved

Is your income likely to change over the next 12 months? *

Yes
No

How do you expect your income to change? *

Are your expenses likely to change over the next 12 months? *

Yes
No

How do you expect your expenses to change? *

Anything extra

If there is anything else you would like to tell us:

Privacy Declaration & the Disclosure Statement *

Tick box to accept the Privacy Declaration & the Disclosure Statement

I hereby consent to electronic disclosure to the email address provided in this Application and consent and agree to the terms of the Privacy Declaration. You also confirm you have read and understood our Disclosure Statement and the type of advice we do and do not offer.