Primary customer

Current annual income

Type
Salary/wages (before tax)
Amount
$
Commission (before tax)
$
Self employed/contract
$
Beneficiary income
$
Car allowance
$
Rental income
$
Boarder income
$
Other
$
Total
$

Secondary customer

Does this assessment involve a secondary person?

Assets

Type
Property
Estimated value
$
KiwiSaver
$
Vehicle
$
Savings
$
Other
$
Total
$

Liabilities not with Kiwibank

Loan type
Home loan
Financial institution
Limit
$
Outstanding balance
$
Monthly repayment
$
Personal loans
$
$
$
Credit cards
$
$
$
Overdrafts
$
$
$
Student loans
$
$
$
Other
$
$
$
Total
$

Personal living expenses

Personal living expenses
Home, contents and vehicle insurance
Monthly amount
$
Life, income and health insurance
$
Landline, internet and mobile phone/s
$
Electricity, gas, heating
$
Housing rates, water rates, house maintenance
$
Groceries and food
$
Clothing and footwear
$
Healthcare
$
Transportation and vehicle maintenance
$
Education, childcare, family support
$
Other regular expenditure (rent/board, pay TV, memberships, tithing)
$
Total
$


Do you have any payments that are overdue?
Have you provided security (e.g. as a guarantor to a loan) over your assets to a third party or have any other such financial obligations?
Preferred contact time
Please check we have the correct phone number for you in internet banking or the mobile app, under Settings.

Terms and conditions

Full name
Date