Driver's Licence No (5a):
Driver's Licence Version (5b):
Information Statement/Authorisation Pursuant To The Privacy Act 1993
Please read this statement/authorisation notice in full.
Have you ever had or are there now any attachments or legal proceeding against you,
or any action for payment default?
If yes, please state details:
Where the applicant is a limited liability company, this authority and acknowledgement applies to all directors of that company.
I/We understand that I am/we are not required to provide any personal
information to the dealer/broker named in this application for finance
(application), but that failure to do so may prejudice my/our chances of
I/We certify that the information in this application is true and
correct, and that I am/we are over the age of 18 years and I am/we are
not an undischarged bankrupt(s).
I am/We are aware that the information in this application is
collected initially for the purpose of considering my/our application
for finance, and may be given to a number of lender's at the discretion
of the dealer/broker. If this application is approved, I/we understand
that the information will be used by the lender for the purpose of
administering the loan. I/We agree that the lender may send me/us
details of other products and services from time to time and may use all
personal information held about me/us for the purpose of considering
any future application for finance made by me/us and/or offering me/us
further financial accomodation.
By completing this application I/We authorise the dealer/broker and/or lender;
- to collect from credit reporting agencies, credit providers, my/our
employer(s), accountant(s) or other named persons, such personal,
financial and commercial information and references about me/us as is
necessary for the purpose of considering this application, and for those
third parties to disclose information to the dealer/broker/and or
- to disclose personal information about me/us to credit reporting and
debt collection agencies in the event of any default in any sum owing
to the lender, and also to any third party making an authorised enquiry
Paul Kelly Motor Company Dancers, who perform at the Canterbury NPC and mighty Crusaders Rugby Matches.