Robertson Holden - Application for Credit

Purchase Price $ Deposit $ Trade-In $

Applicant Surname Applicant First Names Marital Status No. of Dependants Spouse Surname Spouse First Names Applicant Date of Birth Spouse Date of Birth Applicant Driver's Licence No. Version No. Spouse Driver's Licence No. Version No.
Phone No. (hm) Phone No. (mobile) Phone No. (wk) Email Fax No.

Address & Tenancy:
Own House / Renting / Boarding / Family House / Other (Details)
Current Address Years
Previous Address Years

Present Employer Occupation
Address Years
Previous Employer Occupation Years

Spouse's Employer Occupation
Address Years

Nearest Relative (or Close Friend) Relationship
Address Phone No.
Another Contact (Non Relative) Relationship Address Phone No.

Account References (Hire Purchase/Credit Card,etc.)
1. 2.
Bankers Account No.

Assets

Home $ Furnishings $ Bank $ Car $ Investments $ Other $ TOTAL $

Liabilities

Mortgages $ HP/credit accounts $ Bank O/D $ Other creditors/loans $ TOTAL $ NET WORTH $

Income (monthly)

Applicant average take home pay $ Spouse's take home pay $ Other income $ TOTAL $

Privacy Consent

I/We understand that I am/we are not required to provide any personal information to ROBERTSON HOLDEN*, but that failure to do so may prejudice my/our chances of obtaining finance.

I/We certify that the information in this application 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).

I am/we are aware that the information in this application is collected initially for the purpose of considering my/our application for finance, and may be given to a number of lender's at the discretion of ROBERTSON HOLDEN, but solely for the purpose of the subject application. If this application is approved, I/we understand that the information will be used by the lender for the purpose of administering the loan. I/we agree that the lender may send me/us details of other products and services from time to time and may use all personal information held about me/us for the purpose of considering any future application for finance made by me/us and/or offering me/us further financial accommodation.

By completing this application, I/We authorise ROBERTSON HOLDEN and/or lender(s);
To collect from credit reporting agencies, credit providers, my/our employer(s), accountant(s) or other named persons, such personal, financial and commercial information and references about me/us as is necessary for the purpose of considering this application, and for those third parties to disclose information to ROBERTSON HOLDEN and/or lender(s);
To disclose personal information about me/us to credit reporting and debt collection agencies in the event of any default in any sum owing to the lender(s), and also to any third party making an authorised enquiry about me/us.

I/We understand that, pursuant to the Privacy Act 1993, I/we have the right to request access to and correction of any personal information held by Roberson Holden and/or lender(s)

*ROBERTSON HOLDEN means Manawatu Motors 1970 Limited T/A Robertson Holden or Manawatu Motors 1970 Limited T/A Robertson Isuzu Truck Services.

I/we authorise ROBERTSON HOLDEN* to collect, retain and use personal information about me/us, for the purposes of:
Assessing my/our credit worthiness;
Attending to the financing, whether directly or indirectly, of my/our contract(s) and enforcing ROBERTSON HOLDEN rights thereunder;
Marketing and/or informing me/us about the goods and services provided by ROBERTSON HOLDEN and any finance company nominated by ROBERTSON HOLDEN.
I/we authorise ROBERTSON HOLDEN to collect from credit reporting agencies, credit providers, my/our employer(s), accountant(s), relatives, or other person(s) such personal, financial and commercial information about me/us for the said purposes.
I/we authorise ROBERTSON HOLDEN to provide this information:
To any person for the foregoing purposes;
To employees and agents of ROBERTSON HOLDEN, any finance company nominated by ROBERTSON HOLDEN and any other person, in any ordinary course of business, for any of the foregoing purposes;
To credit agencies for the purpose of maintaining proper or effective records.
I/we acknowledge that if I/we do not provide all or any part of the information requested on this application form, my/our application for finance may be declined. I/we further acknowledge that, pursuant to the Privacy Act 1993, I/we have a right of access to information collected by ROBERTSON HOLDEN about me/us and to request that this information be corrected. The information will be held at the office of ROBERTSON HOLDEN House, 451 Rangitikei Street, Cloverlea, Palmerston North.
*ROBERTSON HOLDEN means Manawatu Motors 1970 Limited T/A Robertson Holden or Manawatu Motors 1970 Limited T/A Robertson Isuzu Truck Services.
I/We warrant that the information provided in this application is true and correct.

I agree to the above Privacy Consent.
I warrant that the information provided in this application is true and correct.

Expenses (monthly)

Mortgages/rent payments $ HP/credit accounts $ Rates/phone/power/insurance $ Life insurance/building society $ Car/other expenses $ TOTAL $