Financial Hardship Application | Credit Union baywide

Is this a joint application?

Yes

No

Reason for application

Provide specific details of your change of circumstance, along with your request for assistance.

Primary applicant personal details

Member number

First name

Last name

Middle name(s)

Date of birth - please enter as: DD/MM/YYYY

Have you ever been declared bankrupt or had a No Asset Procedure in New Zealand or had any equivalent order made against you in any other country?

Yes

No

Primary applicant contact details

Email address

Residential address

City

Post code

Best contact number

Name of present employer

Occupation

Employer's address

Secondary applicant personal details

Member number

Last name

First name

Middle name(s)

Date of birth - please enter as: DD/MM/YYYY

Have you ever been declared bankrupt or had a No Asset Procedure in New Zealand or had any equivalent order made against you in any other country?

Yes

No

Secondary applicant contact details

Residential address

City

Post code

Best contact number

Email

Occupation

Employer's address

Please enter in your financial details as based on a weekly basis.
If this is a joint application, please enter in the combined weekly amounts of both applicants.

Income (weekly)

Your net income (After tax)

Other income (including: board payments, working for families, tax credits, child support payments etc. Please specify)

Expenditure (weekly)

Mortgage/Rent/Board

Rates/Water

Living costs (Food, power, insurance, vehicle, telephone etc.)

Hire purchases

Credit cards

Loan/Overdraft

Are you currently acting as a guarantor for any loans or debt?

Yes

No

Commitments

What you owe on your loan/hire purchase(s) / The lender / Weekly repayment amount

What you owe on your student loan / Weekly repayment amount

Please advise any other liability you have on regular basis stating the liability and weekly amount (e.g: pay child support $75 per week/ Childcare costs etc/ medical )

Assets

Home 1 (registered value which can be found on your rates)

Home 2 (registered value which can be found on your rates)

Household contents insured value

Vehicle(s)

Other property (such as boats, caravan, motorbike, etc)

Bank account (including investments)

Superannuation fund

Other

I/we certify and acknowledge that:

All information supplied is true, correct and complete and may be relied upon by Credit Union Baywide.
I/we have not withheld any information (including information regarding bankruptcy or no asset procedure) which may affect Credit Union Baywide's decision regarding this application.
I/we will advise Credit Union Baywide of any changes to relevant personal information including (but not limited to) the information in this application.
Credit Union Baywide may use personal information it holds for the purposes set out in the General Terms and Conditions. This includes (but not limited to) provision of products or services by Credit Union Baywide, market research, legal compliance and promotion of products and services by selected third parties engaged by Credit Union Baywide.
Credit union Baywide may (at its sole discretion) make relevant enquiries in relation to the application, including credit checks and enquiries in relation to my current or past employment.
My personal information may be disclosed to debt recovery and credit reporting agencies, and my personal information may be disclosed by credit reporting agencies to their eligible customers.
I/we have the right to access and correct any information held about me by Credit Union Baywide.
Credit Union Baywide will ensure that information about me is securely held and will not, except as set out in General Terms and Conditions or as authorised by me or when required or authorised by law, be disclosed to any other person or organisation.