Mortgage Application Form

Summary Page
Max purchase price
Total Potential Deposit (from all sources)
Kiwi saver balances, HNZ grant estimates, Savings, Gift, and Other
Deposit Percentage
deposit divide max purchase = %
LVR
deposit divide max purchase = %
C1 Kiwi saver balance
C1 HNZ Grant Estimate
C2 Kiwi saver balance
C2 HNZ Grant Estimate
Savings
Gift
Other
Monthly Debt Repayments
Combined Credit Card limit
Combined Credit Card Balances
Monthly Child Support Payments
Monthly Child Care Fee
Monthly School Fee
Client 1
Age
Income
Length in job
Student Loan
Student Loan Balance
Kiwisaver contribution %
Client 2
Email
Age
Income Two
Length in job
Student Loan
Student Loan Balance
Kiwisaver contribution %
Children
Number of Kids
Kids Ages
Monthly Family Assistance
Monthly Child Support Receive
Debts
Client 1
Personal Loan
Monthly Personal Loan Payments
Car Loan
Monthly Car Loan Payments
Hire Purchase
Monthly Hire Purchase Payments
Tool Account
Monthly Tool Account Payments
Fines
Monthly Fines Payments
Client 2
Personal Loan
Monthly Personal Loan Payments
Car Loan
Monthly Car Loan Payments
Hire Purchase
Monthly Hire Purchase Payments
Tool Account
Monthly Tool Account Payments
Fines
Monthly Fine Payments
PERSONAL DETAILS
To get the ball rolling we ask that you fill in the following form, it is super easy to complete and 100% obligation free at this point.

In most cases we charge a $250 fee we will confirm this before you come and this doesn’t have to be paid until after the meeting, or if it will differ.

If after assessment of this initial enquiry form, Brenda feels a loan approval would be unlikely, Brenda will advise you of this and what options you may have for the future.

Once you have completed the form, Click SUBMIT. We will contact you to discuss your options and arrange an initial meeting.

Before proceeding, please read our Privacy Statement below.
Privacy Statement
1. The personal information collected in this Initial Enquiry Form will be used to determine initial eligibility for potential home and/or personal loans and if necessary gain a credit check assessment.

2. Brenda Nom Mortgage and Insurances Limited undertake to keep this information confidential and secure. This information may be in paper format and/or electronic files and/or held remotely in secure electronic storage systems.

3. I am required to keep these records on file for a period of 7 years or longer whether or not this engagement terminates.

4. Besides our staff we may share this information with potential loan providers and credit checking agencies.

5. Providing some information is optional. If you choose not to enter financial information we will be unable to determine loan eligibility.

6. You have the right to ask for a copy of any personal information we hold about you and to ask for it to be corrected if you think it is wrong. If you like to ask for a copy of your information or have it corrected please contact us at info@brendanom.co.nz or 03 2149292 or 12 Don Street, Invercargill.
Do you agree to the above Privacy Waiver and service agreement*
- Yes
ENQUIRY DATE:*
Date Format: DD slash MM slash YYYY
Number of applicants*

- Client Name: 1*
  First Last
- Date of Birth
- - DD*
  - MM*
  - YYYY*
- Age:*
- Contact Phone*
- Current Address
  Street Address City State / Province / Region ZIP / Postal Code
- Email*
- NZ Resident*
  - Yes
  - No
- Please take a picture of your visa page/s and email to us at info@brendanom.co.nz
- Client Name: 2*
  First Last
- Date of Birth
- - DD*
  - MM*
  - YYYY*
- Age*
- Contact Phone
- Current Address
  Street Address City State / Province / Region ZIP / Postal Code
- Email*
- NZ Resident 2*
  - Yes
  - No
- Please take a picture of your visa page/s and email to us at info@brendanom.co.nz
REFERRED BY?*
Referred By (Name)
Referred By Other:*
Who do you use for your main banking?*
Bank Name
Client 2: Who do you use for your main banking?*
Bank Name
Have you applied for a home loan with them in the last 6 months?
- Yes
- No
What did they say?

CREDIT HISTORY
Have any of the applicants had any Defaults / Collections in the last 7 years? eg baycorp / Financial institution
- Yes
- No
Are they paid off in full?
- Yes
- No
If so approx what year where they paid?
Approximate amount owed?
Reason for the debt/collection
If these are not paid we suggest you go to Credit Simple and order a copy of your credit report then email it to us once received to info@brendanom.co.nz
Don’t worry about completing the rest of the form as we need to assess your credit history first.

INDICATION OR PRE-APPROVAL
Would you like an indication only of what you maybe able to borrow based on your income and debts if any?
- Yes
- No
Or Do you want to get preapproved* and intend on buying a home in next 3 to 6 months? (appointment required or can do over email and phone if outside of Invercargill)
- Yes
- No
*please note preapprovals in most cases only valid for 3 months
Or Other:
Have you found a house you would like to sign up on?
- Yes
- No
What is the address?
What is the asking price?
Do you know who the real estate agent is?
- Yes
- No
Real Estate Agent Name

Protecting your Home:
Insurance
Many lenders require/prefer insurance to ensure the ability to meet mortgage commitments in the case of unforeseen death, sickness and disability. This may need to be a consideration.

From your perspective, is ensuring you can maintain minimum mortgage commitments and retain your home/investment property important to you?
- Yes
- No
Do you have any of the following insurance covers as your ‘back-up plan’?
- Lump sum cover in case of death (Life Insurance)
- Lump sum cover if suffering specified serious illnesses such as cancer, heart attack or stroke (Trauma /Critical Illness Insurance / Crisis Cover)
- Lump sum cover for a long term / permanent disability (Total and permanent disability Insurance)
- Regular mortgage repayment cover for sickness or disability (Mortgage Repayment Insurance)
- Regular income cover for sickness or disability (Not ACC) (Income Protection Insurance)
Who do you have these covers with?
Do you have an existing insurance adviser?
- Yes
- No
Who are they? Or what is the name of the company they work for?