Statement of position
Property information
As at date
D
D
M
M
Y
Y
Primary property (house and land)
Personal details
Street address Name(s)
Suburb Town/City First Postcode Last Latest government/registered valuation
First Your estimate of current value
Last Amount of mortgage
$
First Maturity date
D
Last Property mortgaged to
Marital status
Date(s) of birth
$
A
$
M
M
Y
Y
D
M
M
Y
Y
D
M
M
Y
Y
Other property 1
D
D
M
M
Y
Y
Single
Married
Defacto
Divorced
D
D
M
M
Y
Y
Single
Married
Defacto
Divorced
Suburb D
D
M
M
Y
Y
Single
Married
Defacto
Divorced
Town/City Street address Postcode Latest government/registered valuation
Home address
$
B
Street address Your estimate of current value
Suburb Amount of mortgage
$
Maturity date
D
Town/City D
Postcode Mailing address
$
Property mortgaged to
Street address Other property 2
Suburb Town/City Street address Postcode Suburb Contact details
Home Business 0 0 Town/City 02 Mobile Fax 0 Latest government/registered valuation
Your estimate of current value
Email By providing your email address, you consent to the BNZ Group contacting you electronically
(e.g. by email, text, website link) from time to time with information about our products,
services, and promotions, and without an unsubscribe facility.
Occupation(s)
Postcode $
B
$
Amount of mortgage
$
Maturity date
D
Property mortgaged to
Public company shares
Company
Employer(s)
Name of shares held
Name Market value per share
$
Market value of holding
$
Company
Name of shares held
Name Banker(s) (if other than BNZ)
Market value per share
$
Market value of holding
$
Company
Name Salary (or last annual income)
$ Name of shares held
Sole
Joint
Market value per share
$
Market value of holding
$
Total
C
$
Statement of position
Liabilities
Assets
What you owe
What you own
Overdraft
Home loan lender 1
Monthly repayments
$
$
Other BNZ accounts
$
Other bank account (specify)
$
$
$
$
$
$
Hire purchase
Monthly repayments
$
Savings account
$
Motor vehicle loan lender
Monthly repayments
Cheque account
$
Home loan lender 2
Monthly repayments
$
$
$
Specify assets
Life insurance cover
$
Surrender value (if applicable)
$
Primary property (copy from A
on page 1)
$
Other property (total value of B
from page 1)
$
Public company shares (copy from C
on page 1)
$
Motor vehicle (year and type)
Other loans
Credit cards (specify)
Limit
$
$
$
$
Amount owing
$
$
$
$
$
$
Other liabilities (over $1000) Limit
Household and personal effects
$
$
$
Total liabilities
$
Sole
$
Joint
$
$
Other assets or investments over $1000
$
Amount owing
$
Liability as Guarantor
$
$
$
Total assets
$
Less total liabilities
$
Net worth (surplus/deficit)
$
Personal information notice
This notice relates to the information you are now providing to BNZ or its
related companies (as defined in section 2(3) of the Companies Act 1993
as if ‘company’ includes a company or other body corporate incorporated in
New Zealand or any other jurisdiction) (each a BNZ Company); any insurance
organisation (including any insurance underwriters or agents) used in relation
to your account; and any other party that we notify you of in the future
(together the ‘Parties’), or which the Parties may hold now or in the future.
1. The Privacy Act 1993 gives you the right to see and correct your
personal information.
5. To gain your views on products and/or services, the Parties may want to
provide your details to market research organisations. If you do not wish
your details to be provided, please tick
2. Your information may be disclosed to any person that has given a
guarantee or other security for your obligations to BNZ.
6. If you do not wish to provide all the information requested, we may restrict
the products, facilities and/or services available to you.
3. Information about you will be used primarily for administering your
account and offering or providing banking and other financial services to
you. Information may be disclosed to another BNZ Company or a third
party in connection with any of these purposes provided the recipient of
the information is subject to an obligation of confidentiality in relation to
that information. Information may also be used to further the relationship
between you and any BNZ Company, the Parties or a third party, and for
marketing purposes. This includes, without limitation, communicating with
you via email, text message, an on-line facility (without an unsubscribe
facility), telephone or post about any products, services or promotions
offered or distributed by any BNZ Company, the Parties or a third party.
Declaration
4. In respect of opening and reviewing accounts, applications and offering
you relevant products and services, you authorise the BNZ Companies
004116-12/11
to make credit reference checks and other enquiries within their normal
procedures. For this purpose, the BNZ Companies may seek information
about you from any source. If you are in default under any loan or facility
from a BNZ Company, the BNZ Companies are authorised to disclose all
relevant information about you to, and for the use of, credit agencies,
debt collection agencies and law firms.
Call us on 0800 955 455
Visit bnzpartners.co.nz
I/We certify that all the information supplied is true and complete. I/We
hereby authorise the Bank to make any enquiries it considers necessary for
confirmation of the above. I/We confirm that we have read and agree to the
personal information notice above.
Signature D
D
M
M
Y
Y
Signature D
D
M
M
Y
Y