Is this a Joint Application? * —Please choose an option—YesNo
Select Your Nearest Branch * Palmerston North
First Name(s) *
Middle Name(s)
Last Name *
Date of Birth *
Marital Status * —Please choose an option—SingleMarried (Your partner is working)Married (Your partner is not working)De Facto Your partner is working)De Facto (Your partner is not working)DivorcedSeparatedWidowed
Number of Dependants *
Gender * —Please choose an option—MaleFemale
Drivers Licence Type * —Please choose an option—Overseas LicenseLearners LicenceRestricted LicenceFull Licence
Drivers Licence No. *
Version No. *
Licence Expiry Date *
Home Phone
Mobile Phone *
Work Phone
Email Address *
Are you NZ Citizen / Resident? * —Please choose an option—YesNoWork Visa
Work Visa Expiry Date *
Address Details * —Please choose an option—MortgageFreeholdRentingBoarderLiving with parentsLiving with Relatives
Cost of every week (in NZ Dollar)
Home Address *
Suburb
City *
Months lived at Address *
Previous Home Address
City
Months lived at Address
Employment Type * —Please choose an option—RetiredHomemakerBeneficiarySelf EmployedFull TimePart TimeStudentPart-time + Beneficiary
Work Type * —Please choose an option—Trade/ConstructionFactorySales/ServiceManagerDefence/PoliceDriverLabourerOffice StaffProfessionalExecutive/Director
Company Name *
Months at Your Job *
Previous Company Name
Months at Your Job
Name *
Relationship *
Phone *
Primary Income Type * —Please choose an option—WagesSalarySelf EmployedContractCasualOther
Amount(in the hand) *
Pay Frequency * —Please choose an option—WeeklyFortnightlyMonthlyOther
Other Income
Other Income Source
Primary Income Type —Please choose an option—WagesSalarySelf EmployedContractCasualOther
Amount(in the hand)
Pay Frequency —Please choose an option—WeeklyFortnightlyMonthlyOther
Address
Value (RV or GV)
Names on Title
Mortgage Balance
Mortgage Repay (monthly)
Is this a Rental? —Please choose an option—YesNo
Rent Income (monthly)
Year
Make
Model
Registration No
Vehicle Current Value
Vehicle Financed By
Amount Still Owing
Monthly Repayments
Description
Market Value
Type * —Please choose an option—RentOther
Amount *
Paid To
Frequency * —Please choose an option—WeeklyFortnightlyMonthlyOther
Type —Please choose an option—RentOther
Amount
Frequency —Please choose an option—WeeklyFortnightlyMonthlyOther
Type —Please choose an option—Secured LoanUnsecured LoanOther
Owed To
Repayments
Still Owing
Please upload necessary documents and its helps us to complete the application faster. Only PNG, JPG, PFD, DOC and DOCX files are allowed. Maximum 2MB per file.
Document One
Document Two
Document Three
Document Four
Comments
I/we authorise Greenland Autos Limited* to collect, retain and use the 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 Greenland Autos Limited’s rights therunder; Marketing and/or informing me/us about the goods and services provided by Greenland Autos Limited I/we authorise Greenland Autos Limited 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 Greenland Autos Limited to provide this information:
To any person for the foregoing purposes; to any employees and agents of Greenland Autos Limited and/or 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 pursant to the Privacy Act 1993, I/we have a right of access to information collected by Greenland Autos Limited about me/us and to request that this information be corrected. The information will be held at the office of Greenland Autos Limited, 657 Main Street, Palmerston North or the registered offices of any party nominated by Greenland Autos Limited.
* Greenland Autos Limited and other associated third parties
To verify your acceptance of the above Privacy act statement please check the box below and click the apply button.
Check the box to accept and continue
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