Affordability & Variation Update Form

Under the Responsible Lending Code we need to confirm you are in a suitable financial position so your new instalment (Installment Frequency) payments will not cause you any undue hardship.

If you could please complete the form then we can process your order.

Or download the PDF form here.

Name

Address

Reference number

Dependants (listing with you including children, extended family etc)

Please increase/decrease my existing installment of to with payments commencing on

Income:

Source (Wages/Winz/IRD etc)

Amount

Main Income

Source

Amount

2nd Income

Source

Amount

Other Income

Source

Amount

Total Income (A)

Total income

Household Expenses:

Accommodation

Mortgage/Rent/Board etc.

Rent

Utilities

Power/Gas/Water etc.

Utilities

Food

Groceries/Lunches/Maccas etc

Food

Living

Car/Insurance/Clothing etc

Listing

Other Finance

Store Cards/Loans/Hire Purchase etc

Finance

Other Expenses

Details

Amount

Total Expenses (B)

Total expenses

Total Disposable Income (A - B)

Total disposable income

I (name in full) confirm that I am 18 years of age (or older) and that the information I have provided is accurate, true and that I have requested the variations to my instalment value, term of contract and total owing.

Identification (License, CSC, Passport Number, Expiry etc)

Signature

This form and the information supplied is protected under the Privacy Act and IS NOT available or accessible to any other individual or business unless ordered to do so by law.

Our last day for Xmas shipping is Friday 6th December

Under the Responsible Lending Code we need to confirm you are in a suitable financial position so your new instalment (Installment Frequency) payments will not cause you any undue hardship.

Income:

Household Expenses:

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