Mr / Mrs / Ms / Miss
Male / Female
Yes / No
Own House / Renting / Boarding

Employment Details

Contact Details (Person not living with you.)

Hire Purchase/Loan References (previous or existing loan)


Financial Details

Weekly Fortnightly Monthly
Net Surplus per Weekly Fortnightly Monthly

Privacy Waiver

I certify that the particulars in this application are true and correct and that I am over the age of eighteen (18) years and am not an un-discharged bankrupt. Pursuant to the Privacy Act 1993, I authorise ANZA Motor Company to contact any credit reporting agencies, credit providers, my employer, accountant or any other source to obtain, check and exchange (both now and in the future) such personal, financial and commercial information and references about me as is necessary for the purposes of considering this application, the protection and administration of any loan arising out of the application, and to assist in the enforcement of any agreement between myself and ANZA Motor Company. This includes checking on Ministry of Justice fines enforcement and obtaining the balances of fines in default (now and in the future). I agree that Anza Motor Company may produce this authority to such parties for the purpose of collecting such information. I note that under the provisions of the Privacy Act 1993 I am entitled to have access and request correction to personal information held about me.

I agree and understand the terms and conditions of the above Privacy Waiver