125 - 127 Gracefield Road, Lower Hutt
Ph. 04 566 6484 04 566 6484

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Please complete the following application form to apply for finance through Trade In Clearance.
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2017 Nissan Note E-POWER
91,789km, Automatic, Hybrid, 1198cc $14,995
No rebate or fee
Applicant
1
Address & Employment
2
Contact
3
Financials
4
Loan Detail
5
Apply
6

1. Applicant Information

Is this a joint application? No
Please enter your first name(s)
Please enter your middle name(s)
Please enter your last name
Please enter your marital status
Please enter the number of dependants
Please enter your drivers licence type
Please enter drivers licence no
Please enter drivers licence version no
Please enter a valid email address
Previous Finance Details

2. Address & Employment

Address Details
Own House
Renting
Boarding
Other
Please enter a Tenancy Type
Please enter a your address
Please enter suburb
Please enter city
Please enter the years lived at the above address
Employment Details
Please enter your employment start month
Please enter your employment start year
Please enter your occupation
Please enter your employer
Please enter hours worked per week
Please enter a your previous address
Please enter suburb
Please enter city
Please enter your employers phone number
Please enter your employment start month
Please enter your employment start year
Please enter your occupation
Please enter your employer
Please enter hours worked per week
Please enter a your previous address
Please enter suburb
Please enter city
Please enter your employers phone number

3. Contact Details

Next of Kin Details (NB - Must not live at the same address as you)
Please enter the name
Please enter the relationship (eg mother/father etc)
Please enter the contact number
Please enter a the address
Please enter the suburb
Please enter the city
Another Contact's Details (eg. Friend, Workmate etc)
Please enter the name
Please enter the relationship (eg mother/father etc)
Please enter the contact number
Please enter a the address
Please enter the suburb
Please enter the city

4. Financials

Income
Applicant 1
Please enter your income type
Please enter the amount in the hand
.00
Please enter your pay frequency
Applicant 2 / Partner Income
.00
Assets
Property 1
.00
.00
.00
Is Rental?
Property 2
.00
.00
.00
Is Rental?
Vehicle 1
.00
.00
.00
Vehicle 2
.00
.00
.00
Other Assets
.00
.00
.00
.00
Outgoings (IE. Your expenses and repayments)
Expenses
.00
.00
.00
.00
Loan Repayments
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00

5. Loan Details

2017 Nissan Note E-POWER
91,789km, Automatic, Hybrid, 1198cc $14,995
No rebate or fee
.00
Please enter the amount you wish to finance
.00
.00
Please describe the vehicle you wish to finance
Please select your preferred payment term
.00
Please enter your preferred repayment amount
Please enter your preferred repayment frequency
Other Information
Do you have any previous credit related issues that may need to be addressed prior to a successful application?
No
Are you an NZ citizen/NZ born?
Yes

Privacy Statement

The Purchaser irrevocably authorises and consents to MVT or any financier, credit reporting agency or any other person or entity required for the purpose of completing this contract requesting, obtaining and retaining any personal information about the Purchaser from any individual, company, state owned enterprise or government department in the public or private sector and the Purchaser irrevocably authorises and consents to any individual, company, state owned enterprise or government department in the public or private sector providing the MVT with such personal information about the Purchaser as requested by MVT.

The Purchaser irrevocably authorises and consents to MVT or any financier, credit reporting agency or any other person or entity required for the purpose of completing this contract providing any personal information held by MVT about the Purchaser to any individual, company, state owned enterprise or government department in the public or private sector.

You authorise the MVT (either directly, via service providers of the MVT, or otherwise) to collect information about you and your interactions with the MVT (including but not limited to your name, contact details, your credit history and payment details, your communication preferences, via methods including but not limited to direct feedback, surveys and social media). This information will be collected, held and used by the MVT and/or service providers of the MVT, and/or it may be disclosed to third parties, for the purpose of:

(a) communicating with you (by telephone, post, email, text or otherwise) in relation to this sale and to seek your feedback on our services;
(b) cooperating with Government, regulatory or industry authorities;
(c) providing you with items on this agreement and any other products or services that you may receive from us, including by sharing information with providers of these products or services;
(d) running and administering promotions and competitions;
(e) marketing and promoting our and/or third party products and services to you.

You acknowledge and agree that such information may be held and used by the MVT and/or service providers of the MVT both before and after termination of this contract, but only in the manners permitted by law.

You acknowledge that, pursuant to the Privacy Act 2020, you have a right to request access to the information collected about you by MVT, or any party nominated by MVT, and also to request that this information be corrected if required. The information will be held at the office of MVT and/or the registered offices of any party nominated by MVT.

Please note: Should you wish to have your name and address made private, you may contact the NZTA and request this be done.

To verify your acceptance of the above Privacy Statement please enter the word ACCEPT into the text box below and click the submit button.

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