PERSONAL DETAILS FOR APPLICANT 1
EMPLOYMENT EMPLOYMENT - APPLICANT 2
PERSONAL DETAILS FOR APPLICANT 2
KRIS PEDERSEN MORTGAGES
APPLICATION FORM
FILL OUT DETAILS BELOW ONLY IF DIFFERENT FROM APPLICANT
Surname
Mr Mrs Ms Miss Dr
First Name(s)
Date of Birth / / Country of Birth
NZ Residency held? Yes No
Marital Status Married Defacto Single
Sex Male Female
Age of Dependants
Current Residential Address
Postal Address (if dierent from above)
Time there Years Months
If less than years what was your previous address
Are you currently? (Please tick one)
Renting Boarding Living in own home Other
Home Phone Number
Work Phone Number
Mobile Phone Number
Email - Home
Work
Surname
Mr Mrs Ms Miss Dr
First Name(s)
Date of Birth / / Country of Birth
NZ Residency held? Yes No
Marital Status Married Defacto Single
Sex Male Female
Age of Dependants
Current Residential Address
Postal Address (if dierent from above)
Time there Years Months
If less than years what was your previous address
Are you currently? (Please tick one)
Renting Boarding Living in own home Other
Home Phone Number
Work Phone Number
Mobile Phone Number
Email - Home
Work
Years Months
Years Months
Salary/Wages Self Employed Other Salary/Wages Self Employed Other
Main Source
of Income
Note
Occupation
Employer/Business Name
Type of Business/industry
How Long Years Months
Annual Income Before Tax
If less than years, please name prior employers – we need a total
of years history;
Years Months
Years Months
Years Months
Main Source
of Income
Note
Occupation
Employer/Business Name
Type of Business/industry
How Long Years Months
Annual Income Before Tax
If less than years, please name prior employers – we need a total
of years history;
Years Months
Years Months
Years Months
Separated
/divorced
Separated
/divorced
PROPOSED MONTHLY INCOME & EXPENDITURE
ANNUAL GROSS
PROPOSED MONTHLY
MONTHLY NET
Salary/Wage
Rental Property Mortgages
Other Mortgage Payments (incl Revolving Credit)
Student Loans
Compulsory Superannuation
Child Support / Child Care
Credit / Charge Cards Limit(s)
PLUS:
Income Protection lns/MPI
Allowance/Cost Life Insurance
Allowance/Cost
Contents Insurance
Dwelling Insurance
Dwelling Rates {incl. water rates)
Medical Insurance
Motor Vehicle Insurance
Motor Vehicle Running & Reg.
Power/Telephone/Gas
Voluntary Superannuation
Food/Clothing/General
Store Cards Limit(s)
Rent to pay ( per week)
Hire Purchase
Other Loans
Lender
Lender
Lender
Lender
. Address:
. Address:
. Address:
. Address:
. Address:
@
@
@
@
@
@
@
$
$
$
$
$
$
$
$
$
$
Business
Benefits
Interest/Dividends
Other
Rental
Boarder/Flatmate
per week
TOTAL INCOME $
SUB TOTAL B
SUB TOTAL C
SUB TOTAL E
TOTAL MONTHLY EXPENSES D+E
NET MONTHLY INCOME A
NET MONTHLY SURPLUS
SUB TOTAL D B + C
TOTAL RENTAL INCOME PER WEEK
A
B
C
E
D
Salary/Wage
Business
Benefits
INCOME EXPENSES
RENTAL INCOME
MONTHLY
PER WEEK
PER WEEK
PER WEEK
PER WEEK
PER WEEK
EXISTING
NEW
REMAINING YEARSREMAINING YEARS
EXISTINGEXISTINGEXISTINGEXISTING
PROPOSED
EXISTING
PROPOSEDPROPOSEDPROPOSEDPROPOSED
NOTE: If you have multiple properties or mortgage
splits and they don’t fit on this page, see our
Property Portfolio Form (last page).
Overdraft Limit
Bank
STATEMENT OF ASSETS AND L IABILITIES AT DATE OF APPLICATION
Main Bank/Branch
ASSETS LIABILITIES
APPROXIMATELY APPROXIMATELY
Money @ Bank/Other
Mortgages
Student Loans
Other Liabilities
Personal Loan
Hire Purchase
Credit/Store/
Charge cards
Superannuation
/Kiwisaver
Life Insurance
Vehicles
Other
Shares
Business Value (Net)
Boat / Caravan
Are you guaranteeing a loan for any other person(s).
Please confirm that this is true and complete, including no active credit cards (Bank, or Gem, Q Card, etc.). Please also be aware that omission
of lending (even by accident) can cause delays to your application and also potentially adversely aect the outcome of your application, so
please ensure this is noted. Lenders have access to credit checks that can see some of this information.
Further notes in support of application:
(If yes provide details):YES NO
Furniture & Personal Eects
Property
. Bank
. From
. From
Limit
Limit
Limit
. From
. From
Lender
Lender
Lender
. Bank
Insurer
$ $
TOTAL ASSETS TOTAL PER TOTAL ASSETS
. Bank
. Bank
. Bank
$
$
TOTAL LIABILITIES
NET SURPLUS
SIGNED DATE
click to sign
signature
click to edit
Do you have any of the following?
INSURANCE QUESTIONS:
MORTGAGE INTEREST RATES:
Do you have sucient life cover to cover your existing or proposed debt?
Do you consider this the minimum amount of cover needed?
Do you have income protection insurance?
If you are self employed, do you have appropriate cover to protect your business assets and income streams?
Have you reviewed your personal insurance requirements in the past  months?
If you answer no or are unsure in regards to any of the above we strongly recommend you have a review as
part of this process. We can introduce you to someone who specialises in this field.
Would you like us to make this Introduction?
Interest rates to be reviewed?
Many people believe that because their rates are fixed, they need to wait until the rate expires before they can make any amendments, but
this isn’t true. As a free service we can review your interest rates, get in touch with lenders and find out firstly; if you have a break fee at all to
break your fixed rates, and if you do, and were to fix on a lower rate, we then run an analysis for you as to whether the new savings outweigh
the break fee. It is common for people tend to get very focussed on the break fee, but if your savings outweigh the break fee, then in many
cases it can make sense to break and re-fix. If you’d like us to run a Break Fee Analysis for you, please refer to our “Property Portfolio Form
on the next page, and tick the box in the right hand column for the applicable mortgage.
Notes:
Insurance Advisor - Risk (Life/Income/Medical)
Insurance Advisor – House, Contents, Car
Property Manager
Accountant
Solicitor
YES
YES
YES
NO
NO
NO
UNSURE
UNSURE
www.krispedersen.co.nz
 Lake Rd, Takapuna, Auckland 
TEL: +    | EMAIL: info@krispedersen.co.nz.co.nz