Application Form

Application Form
I/We wish to apply for a: ⃝ Home Loan ⃝ Residential Rental Loan ⃝ Commercial Loan ⃝ Rural Loan
This is an application for a: ⃝ New loan ⃝ Top up for an existing loan ⃝ Refinance of an existing loan
Personal Details First Client Second Client
First Name
Middle Name(s)
Surname
Date of Birth
Gender
Country of Birth
Marital Status
Mobile Phone
Email Address
Residential Address
Dependants
Name: Name: Name:
Date of Birth: Date of Birth: Date of Birth:
Employment First Client Second Client
Occupation
Employer Name
Industry
Type ⃝ Salary ⃝ Wage ⃝ Salary ⃝ Wage
Status ⃝ Full Time ⃝ Part Time ⃝ Contract ⃝ Full Time ⃝ Part Time ⃝ Contract
How long have you been with
this employer or been selfemployed?
If less than 3 years what was
your previous role(s)?
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myles@aslmortgages.nz 021 983440 | bryce@aslmortgages.nz 027 9408744 | grant@aslmortgages.nz 021 808490 Page 1 of 3

Application Form
Annual Income First Client Second Client
Salary/Wages
Bonus
Investment Income
Other (please specify)
Assets
Property/Shares/Cash/Business
Value / RV GV /
S&P / Market
Ownership
Personal/Joint/Trust/LTC
Bank Limit Balance Monthly
Interest
Payment
Monthly
Income /
Rent
TOTAL
Liabilities
Overdraft/Credit Card/Personal Loan/Hire Purchase/IRD/Other
Limit Balance Monthly Interest
Payment
TOTAL
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myles@aslmortgages.nz 021 983440 | bryce@aslmortgages.nz 027 9408744 | grant@aslmortgages.nz 021 808490 Page 2 of 3

Application Form
Are you a Guarantor? Are you acting as a guarantor for any other liabilities or guaranteeing a loan for any other person(s)? ⃝ No ⃝ Yes provide details
Description of loan requested:
Security offered:
Term required:
Other loans on the same security:
Business / Personal History:
Professional Contacts Person Acting Company Name Phone Email
Lawyer
Accountant
I have attached:
⃝ Latest valuation ⃝ Registered valuation (can be historical) ⃝ Latest financial information relating to business activities
⃝ Copies of any fixed price contracts ⃝ Copy of Drivers License or Passport ⃝ Sale and Purchase Agreements
Client Name
Signature
First Client
Second Client
Date
www.aslmortgages.nz
myles@aslmortgages.nz 021 983440 | bryce@aslmortgages.nz 027 9408744 | grant@aslmortgages.nz 021 808490 Page 3 of 3