APPLICATION

Trust, Family, Understanding & A Smile

Loan Application Form - PERSONAL LOANS

for SINGLE PERSON borrowers

Security offered

Amount of loan required:

Security offered:

Personal Details
Title:	First Names:
	Surname:
	Date of birth:
	Marital Status:	Single Married Other
	Dependants:

Housing Details
Your home	Own Rent Board Other
Current address:
How long have you lived at this address?:	Years Months

Contact Details
Home Phone:
Mobile Phone:
email address:

Employment Details
Occupation/Type of benefit:
Company you work for:
How long have you been working there or on the benefit?	Years Months

Income Details
After tax income per month:	$
Other after tax income:	$

Financial Position
Assets		Liabilities		Monthly Payments	Limit
Money in Bank	$	Overdraft	$	$	$
Home/Section	$	Mortgage/Rent	$	$	$
Car(s)	$	Hire Purchase	$	$
Furniture	$	Hire Purchase	$	$
Business	$	Credit Card	$	$	$
Other	$	Other	$	$	$

Additional Comments

DOCUMENTATION

Items that you will be required to fax, post or bring in to us are:

Drivers Licence copies
Payslips
30 Day (current) Bank Statement
Details of your vehicle or contents insurance

How did you hear about Pacific Loans Ltd

DECLARATION

I declare that the above application is true and correct and no money is owing on the security being provided other than that which is being declared.

PRIVACY ACT

I/We irrevocably authorise any person or company to provide Pacific Loans Ltd/Pacific Finance Ltd, it's employees and agents, with such information as Pacific Loans Ltd/Pacific Finance Ltd, may require in response to it's credit enquiries. I/We irrevocably authorise Pacific Loans Ltd/Pacific Finance Ltd, it's employees and agents, to furnish to any third party details of this application and any subsequent dealings that I/We may have with Pacific Loans Ltd/Pacific Finance Ltd as a result of this application being actioned by Pacific Loans Ltd/Pacific Finance Ltd.

This form remains the property of the Pacific Loans Ltd/Pacific Finance Ltd group of companies.

Type YES in this box to acknowledge that you have read, understood and agreed to the the Terms of Trade.