Loan application

Today’s date Finance Date Settlement Date

Summary information (Office use only)

Loan request Lender
Lenders mortgage insurance premium $ Add to loan? Yes No
New purchase Refinance Building Top up
LM Branch Consultant
Loan in name of Security in name of
Identification Identification

Applicant one personal details Applicant two personal details

Title Mr. Title Mrs.
Surname Saboor Surname Saboor
First names Abdul First names Maimoona Abdul
Date of birth 27-04-1983 Date of birth 12-04-1990
Number of dependents
02 Ages 04 Yr, 02 Yr Number of dependents 02 Ages 04 Yr, 02 Yr
Marital status Marital status
Married ✔ De facto Single Married ✔ De facto Single
NZ residency held? Yes No NZ residency held? Yes No
Are you currently Are you currently
Renting ✔ Boarding Renting Boarding
Living in own home Other Living in own home Other
Street address 59 Oxford Street Street address 59 Oxford Street
Suburb South Dunedin Suburb South Dunedin
City/town
Dunedin Postcode 9012 City/town
Dunedin Postcode 9012
Number of years at this address 02 Yr Number of years at this address 02 Yr
Previous address Previous address
2/19 Cargill Street, City Center, Dunedin 9016 2/19 Cargill Street, City Center, Dunedin 9016

Number of years at previous address 02 Yr Number of years at previous address 02 Yr

Home phone: Home phone:
Work phone: Work phone:
Fax: Mobile: 0276488681 Fax: Mobile: 02040581010
Email: abdulsaboor@gmail.com Email: maimoona.choudhry@gmail.com
Postal address: Postal address:
59 Oxford Street, South Dunedin, Dunedin 9012 59 Oxford Street, South Dunedin, Dunedin 9012

Loan Market l Client fact find & loan application 5

 Applicant one personal details Applicant two personal details

Current employment Current employment

Source of income Source of income
Salary/wages ✔ Salary/wages
Self employed Self employed
Other Other ✔ Not Working

Employer Aurora Energy Ltd Employer

Your position Senior Egineer SCADA & Secondary Systems Your position
Length of time with this employer 04 Yr & 04 month Length of time with this employer

Previous employment (if less than 2 years) Previous employment (if less than 2 years)
Employer Employer
Your position Your position
Length of time with this employer Length of time with this employer

Loan Market l Client fact find & loan application 6

 Assets/Liabilities

Liabilities Assets
Home loans (include lender) rate% $ Property (include address) $
None None
- -
- -
-
Credit cards/store cards $ Limit $ Cash funds $
Master Card 5000 5000
Bank Kiwi Bank 24,000
-
- Bank DBS Bank Singapore 80,000

- Bank
Hire purchase (details) $ Cost/month $ Balance Shares
-
Vehicles $
- Personal Car 2,000
- -

Other loans (details) $ Cost/month $ Balance Life insurance (details)

None
- Company Face value Cash value
None
-
- -
-
IRD/Student loan None

$ Limit $ Balance Medical cover (details)

Bank - overdraft limit N.A
Company $ Month/cost
- term loan N.A None
-

Total liabilities (B) $ 5000

Superannuation (details) $
Are you acting as guarantor for any other liabilities? KIWI Saver 20,592
(Please specify)
-

Solicitor details Furniture/other assets (details) $

Name Jane Fletcher House Items 4,000

Company Downie Stewart

Address
Level 8, 265 Princes Street, Dunedin 9016

Email JaneF@downiestewart.co.nz
Phone Fax Total assets (A) $
DX 034-772-262 Nett assets (A-B) $

Date Signed

Date Signed

Loan Market l Client fact find & loan application 7

 Annual gross income Monthly expenditure
Applicant 1 Applicant 2 This loan

Gross salary/wages 0 Other mortgage repayments 0

Overtime 0 Hire purchase repayments

Second job 0 Other loan repayments 0

Rentals 0 Credit cards/store accounts

Other 0 Child maintenance/child care 0

Total (Annual) 0 Motor vehicle expenses 100

Life/medical insurance 0
Monthly net income Superannuation
Applicant 1 Rates 0

Applicant 2 House and contents insurance

Welfare benefits Other household expenses
(Estimate amount for electricity, gas, telephone, maintenance etc)
Other income (specify)
Other income (specify) Living expenses

Total income Other (Specify)

Total monthly expenses

Monthly expenditure after loan settlement

New/existing Loan $ Table - I/O or R/C % p.a. Years Fixed/Variable W/F/M

Loan Market l Client fact find & loan application 8

 Declarations and privacy act
Name of broker Solomon Kurukuntala
Authorised licensee for Loanmarket Group

Declaration required and this valuation report remains the property of the lender.
I/We authorise that the information contained in this application form f. I/We undertake to pay the lenders fee for processing this application.
may be used by and relied on by the lending institutions listed below. g. The home loan product I/we have applied for has been chosen by me/us as the
This will include the lenders respective Mortgage Guarantee Insurance most suitable product to meet my/our requirements.
Company and credit reference agencies. h. I/We acknowledge that the broker (and any agent, licensee, franchisee or
employee of the broker) is not an agent of the lender and has no authority to act
Authorised institutions include: ANZ, ASAP Finance, ASB, Avanti Finance, Axis on behalf of the lender in any capacity or to bind the lender to any arrangement
Finance, DBR Limited, Deposit Power, General Finance, Home Mortgages,
Liberty Finance, NZ Home Bonds, Presto Mortgages, Savings and Loans, SBS
with me/us.
Banking, Southern Cross Finance Ltd, Sovereign, The National Bank of New i. I/we acknowledge that any fee charged by the broker (or any agent, licensee,
Zealand, Westpac, Other franchisee, or employee of the broker) for services relating to the loan application
Privacy act has been disclosed to me/us and that it only relates to services provided by the
Pursuant to the PRIVACY ACT 1993, I/we acknowledge that the follow- broker and is not in any way associated with the services provided by the lender.
ing has been brought to my/our attention.
Commission disclosure
1. This application form collects personal information about me/us.
I/We acknowledge that I/We have appointed the Loan Market Group representa-
2. The information is collected to determine the eligibility for the credit
tive to act on my/our behalf in obtaining mortgage finance. I/We understand that
I/we seek. The intended “recipients” of the information are any of the
the information will be used by the lender for the purpose of administering the
lenders listed above, providers of credit, credit reference agencies, pre-
loan, and by the lender, Loan Market Group and the broker for administering
vious and current employers, Loan Market Group, the broker, lender’s
any ongoing commission payments to the broker. I/We understand Loan Market
mortgage insurer, parties contracted to the lender, security trustees or
Group has an arrangement with the lender and that the lender will pay an ongoing
any potential or actual assignee of the lender’s rights.
commission over the term of my/our loan, and will periodically disclose the loan
3. The information is being collected and held by the above named
balance to Loan Market Group. Loan Market Group may disclose this information
Loan Market Group representative and the contracted aggregator, Loan
to the broker.
Market Group.
I/We understand that the lending institution will pay Loan Market Group or an as-
4. I/We do have rights of access to, and correction of, this information to
sociated entity a fee and that part of this fee may be passed on to the broker and
the extent that I/we are not entitled or obliged to withhold that informa-
the referring business and/or individual subject to my/our finance being approved.
tion pursuant to S.29, Privacy Act 1993.
I/We authorise the finance approval to be forwarded to the Loan Market Group
5. If the above information is provided by someone other than the Ap-
representative and my/our solicitor.
plicant, I am authorised to provide information on behalf of the Applicant
The Loan Market Group representative may refer your details to other financial
and evidence of this authority is provided.
services providers (e.g. Insurance) who may offer you relevant products. The
6. In making this application, I/We authorise:
Loan Market Group representative may receive a referral fee from any such
• The use of the personal information held for the purpose of advising
providers.
me/us during the term of the loan in relation to any queries I/we may
have and of any other products and services managed or promoted by Insurance requirements
the recipients. I/We acknowledge that, as part of the intended financing transaction and ap-
• The collection of personal information about me/us held by third par- plication date, I/We should review my/our personal risk insurance requirements.
ties including any other credit providers and credit reference agencies, The signing of this application in no way implies an application has been made,
any previous or current employer(s) regarding my employment history with the consultant, for cover and that insurance proposal forms would need to
or income and any other person or body in order to verify the details be completed and accepted by an insurance company before any cover can
contained in this application and to check my/our credit status now or in commence. This is an acknowledgement that the issues have been raised by the
the future. consultant and discussed with me/us.
• The storage of my/our personal information on the systems of the
recipients and the credit reference agencies. Other products
• The recipients to disclose to their credit reference agencies or any oth- I understand that Loan Market Group, the broker and lender might also use my
er agency or party, at any time, personal information relevant to credit personal information for the purpose of market research and from time to time to
enquiries held by recipients including changes in personal information notify me of products or services that may be of interest to me.
and defaults in any payment obligations. I would like information about the following products:
• The credit reference agencies to use my/our personal information now
and in the future to provide credit reporting services to the recipients, Cheque/savings account Credit cards Insurance
its customers and subscribers of their services (such services including Additional documentation
monitoring services to receive updates of my/our personal information
including any default in payment obligations). ✔ Yes No I acknowledge that I/We have been provided with and
• Any of the recipients and any other organisation to collect from the understand my copy of the Advisers Personal Disclosure
lender information about me/us which is connected with an necessary Statement.
for the evaluation by such part of my/our borrowing or any security or
insurance risk.
• The recipients to supply at their discretion, details of this application or
any loan details to a guarantor or proposed guarantor.
Signature of applicant 1
I/We declare as follows:
a. The information contained in this application is true and correct.
b. I/We have not withheld any information on my/our financial position,
commitments, income, employment history or credit history that might Date
affect the lenders decision on this application.
c. I/We have not been declared bankrupt or had any judgements en-
tered against me/us. Signature of applicant 2
d. I/We undertake to pay all costs in connection with the execution and
registration of any security required by the lender in the event of this
application being approved and the release of security when the loan is
repaid.
e. I/We will pay the lenders fee for a valuation report on the property if Date
Loan Market l Client fact find & loan application 11
 Checklist

Document Attached Forthcoming Comment

Signed application form

Diary note

Identification

Proof or residency

Credit checks

Proof of income

Sales and purchase agreement

Valuation(s)

Proof of deposit

3 Month bank statements

6 Month mortgage statements

Building contract

Gifts/statutory declaration

Certificate of incorporation

Trust deed

Other

Other

Other

Other

Loan Market l Client fact find & loan application 12

Disclosure document
Name of financial adviser Solomon Kurukuntala
Address 4A Alana Pl Mt Wellington Auckland
Trading name Keynote Financial Services Limited
Telephone number 09 525 1461/ 021 035 0308
Fax number 09 834 3456
Email address solomon.kurukuntala@loanmarket.co.nz

This disclosure statement was prepared on

It is important that you read this document

This information will help you to choose a financial adviser that best suits your needs. It will also provide some useful information about
the financial adviser that you choose.

What sort of adviser am I?

I am a registered, but not authorised, financial adviser.
I can give you advice about

What should you do if something goes wrong?

If you have a problem, concern, or complaint about any part of my service, please tell me so that
I can try to fix the problem.
You may contact the internal complaints scheme by

Phone, email or write to me on the above contact details.

If we cannot agree on how to fix the issue, or if you decide not to use the internal complaints scheme, you can contact

Financial Services Complaints Limited

This service will cost you nothing, and will help us resolve any disagreements. You can contact FSCL at:
Address P.O Box 5967 Lammbton Quay Wellington
Telephone number 0800 347 257
Email address info@fscl.org.nz

How am I regulated by the government?

You can check that I am a registered financial adviser at http://www.fspr.govt.nz
The Financial Markets Authority regulates financial advisers. Contact the Financial Markets Authority for more information, including
financial tips and warnings.
You can report information or complain about my conduct to the Financial Markets Authority, but in the event of a disagreement, you
may choose to first use the dispute resolution procedures described above (under What should you do if something goes wrong?).

Declaration
I, Solomon Kurukuntala , declare that, to the best of my knowledge and belief, the information contained in this disclosure
statement is true and complete and complies with the disclosure requirements in the Financial Advisers Act 2008 and the Financial
Advisers (Disclosure) Regulations 2010.

Signed Date

I/we have been provided with a copy of this disclosure statement.

Signed Date

Signed Date