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1. Applicant Details
Date of Birth
Drivers License Number
Years lived at current address?
2. Loan Details
I am wanting to finance:
3. Legal Stuff
Information about each person named in this form (Relevant Person) may be collected and held by Heartland Bank Limited, its trading division MARAC, its related entities, successors, assigns, agents and associates (Heartland). That information may be used by Heartland to consider this application for products or services (and any future application involving the Relevant Person). If the information is not provided, Heartland may not be able to provide the requested products or services. The information may also be used by Heartland to develop and run its business, including administering and monitoring products or services provided to the Relevant Person (or any related entity), compliance with legal and regulatory requirements (including identity verification requirements) and providing the Relevant Person with information about other products or services, including those of selected third parties.For the above purposes, the Relevant Person acknowledges that Heartland may provide and obtain information about the Relevant Person to or from other organisations or people Heartland considers appropriate, including its service providers, other financial and insurance institutions, government departments, the Relevant Person’s employer/accountant, and other appropriate persons. Heartland may use the services of credit reporting agencies on an ongoing basis for purposes relating to the provision of credit to the Relevant Person (or any related entity), and may exchange information about the Relevant Person with those agencies, including default information. Those agencies may retain that information and provide that information to other customers who use their credit reporting services. Each Relevant Person may request the full details of every organisation or person to whom Heartland has disclosed information about the Relevant Person. Individuals have rights to access and request correction of their personal information under the Privacy Act 1993.
I/We certify as or on behalf of the Applicant that the information in this form is true and correct.
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 declare that I/We have read and understood the provisions contained in this Application.
By submitting your application to Go Finance Ltd, you are inviting and inviting Go Finance Ltd (and nominated third parties) to contact you (including by phone and email) in relation to discussing and finalising finance, GAP and LPI insurance, extended warranty products and other products which may be of interest to you.
To submit your application please type ACCEPT in capital letters below:
PHONE: 0800 800 930 | EMAIL: email@example.com
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