ANGEL FUND
– WAHINE PUTEA LOAN APPLICATION
| NAME: |
..................................................................................................... |
| Have
you ever been known by any other name? |
..................................................................................................... |
| ADDRESS: |
..................................................................................................... |
| EMAIL: |
..................................................................................................... |
| PHONE/MOBILE
NUMBERS: |
..................................................................................................... |
| DATE
OF BIRTH: |
..................................................................................................... |
| PHOTO
ID / DRIVERS LICENSE NO: |
..................................................................................................... |
ETHNICITY:
(for statistical
purposes only) |
..................................................................................................... |
| AMOUNT
REQUESTED: |
..................................................................................................... |
REASON
FOR LOAN:
**** Attach
quote showing cost of item the loan will be used for |
..................................................................................................... |
|
NAMES, ADDRESSES
& PH. NUMBERS OF THREE REFEREES:
(prefer able
to be contacted in business hours / known for over 12 months / only one
from family)
| 1: |
................................................................................................................................. |
| 2: |
................................................................................................................................. |
| 3: |
................................................................................................................................. |
THE ANGEL FUND
NEEDS ASSURANCE OF YOUR ABILITY TO REPAY YOUR LOAN.
| Where
does your weekly income come from? (eg benefit, part-time work) |
..................................................................................................... |
| Could
you borrow the money from somewhere else? |
..................................................................................................... |
| DETAILS
OF ANY CURRENT DEBTS - Please list any Debts, e.g. H.P. Store cards, Credit
cards, Loans (show amount owing and limit) |
..................................................................................................... |
| Do
you have any Savings? If yes, how much ? |
..................................................................................................... |
BUDGET
| TOTAL
WEEKLY INCOME |
.....................................................................................................
(attach proof
of income - e.g. bank statement or letter from WINZ) |
WEEKLY SPENDING
| FOOD
& HOUSEKEEPING |
..................................................................................................... |
| RENT/BOARD |
..................................................................................................... |
| POWER |
..................................................................................................... |
| PHONE
& TOLLS |
..................................................................................................... |
| PETROL |
..................................................................................................... |
CAR
MAINTENANCE
(Registration,
w.o.f., etc.) |
..................................................................................................... |
| FARES |
..................................................................................................... |
| CHILDCARE |
..................................................................................................... |
| INSURANCES |
..................................................................................................... |
| SPORTS
& CLUBS |
..................................................................................................... |
| HIRE
PURCHASE |
..................................................................................................... |
| LOANS |
..................................................................................................... |
| PETS |
..................................................................................................... |
| CLOTHING |
..................................................................................................... |
| GIFTS |
..................................................................................................... |
HEALTH
- DOCTOR,
DENTIST, MEDICINES |
..................................................................................................... |
| LEISURE,
e.g. video hire |
..................................................................................................... |
| OTHER |
..................................................................................................... |
| TOTAL |
..................................................................................................... |
| INCOME
(from above) |
..................................................................................................... |
| -
WEEKLY EXPENSES |
..................................................................................................... |
| =
SURPLUS |
..................................................................................................... |
I ....................................................
declare that I have provided full and accurate information. I authorise
any person or company to provide the officers and employees of the Angel
Fund with such information as the Fund may require in response to its credit
inquiries. I further authorise the officers and employees of the
Angel Fund to furnish to any third party details of this application and
any subsequent dealings that I may have with the Fund as a result of this
application being actioned by the fund.
Signed:
Date:
This information
is being held under the terms of the Privacy Act 1993. You have a
right to request, view, or correct personal information held by the Angel
Fund.
Check list:
Have you attached
1) Bank
statement or other proof of income (eg Winz letter)
2) Quote
or similar showing cost of items the loan will be used for.
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