Loan Application Form Title Mr Mrs Ms Miss Dr First Name Middle Name Last Name E-mail Date of Birth Please use the date picker or enter the date in the following format: MMM D YYYY (Oct 9 1992) Marital Status Single Married Defacto Other Please Specify Your Marital Status Gender Male Female Other Residency Status NZ Citizen NZ Resident Work & Income Number Mobile Phone Number Home Phone Number Work Phone Number Facebook Name Current Address Address Status Rent Board Own House - Mortgage Own House - Freehold Who are you Boarding with? Street Name Street Number Unit Number If Applicable Area City How long have you lived at your current address Number of years Number of months Previous Address Address Status Rent Board Own House - Mortgage Own House - Freehold Who were you Boarding with? Street Name Street Number Unit Number If Applicable Area City How long did you live here: e.g. 5 Years