Premium Credit Card Application
Welcome to your application for an ANZ Premium Credit Card. Please fill it in using a ballpoint pen and capital letters. If you have any questions, call us on 0800 ANZ CARDS (0800 269 227).
Section 1: Introduction – I am (please tick one):
Already an ANZ customer My ANZ account number is: My ANZ Credit Card number is: A new ANZ customer (note: you’ll need to include proof of your identity with your application – see section 12) Are you a permanent New Zealand resident? Yes No (If no, you need to call 0800 ANZ 2 YOU to see if you are eligible to apply.)
Yes, I have a good credit rating. (ANZ reserves the right to decline applicants who have an unsatisfactory credit history.)
Section 2: I would like to apply for a: (please tick one) Gold Card
ANZ Visa Gold ANZ Gold MasterCard
Platinum Card
Qantas ANZ Visa
Qantas ANZ Visa Platinum Qantas Frequent Flyer number
ANZ Visa Platinum
Only complete if applying for a Qantas ANZ Visa
To ensure that you earn Qantas Frequent Flyer points directly, please provide your Qantas Frequent Flyer number. If you are not already a Qantas Frequent Flyer member, please call 0800 101 500 or visit www.qantas.com/frequentflyer to apply. A $50 joining fee will apply.
My income is over $60,000 per annum.
My income is over $70,000 per annum.
Section 3: More about you
My Name: Title My date of birth: D D M M Y Y Y Y First Name My marital status: Single Married De facto Separated Divorced I’ve been living here for: Years Suburb: Town/City: Months Widowed Middle Name Last Name
My house/RD number:
Street name (please supply a street address, not a PO Box number):
My living arrangements: Own my own home Renting Boarding Living with my parents Number of dependent children I lived there for: Years My mailing address (if different from home address): Months
My previous address (if you’ve been living at your current address for less than two years):
My home phone number:
My mobile number:
The name I’d like on my card:
Section 4: Where do you work?
I am: Self employed Employed by someone else I’ve worked here for Years Months
My employer’s/my business name:
My occupation:
My employer’s address:
My work phone number:
Section 5: Important security information
Name of my closest relative in New Zealand (someone who doesn’t live with you): Their relationship to me: Their phone number:
Their address:
Security password: (required as a security measure to assist customer identification)
Section 6: An additional card (optional)
I’d like an additional ANZ Credit Card for someone else. (Note: they must be aged 16 years or over and you will be responsible for any transactions they make). Their Name: Title Their date of birth: D D M M Y Y Y Y First Name The name they’d like on their card: Middle Name Last Name
Section 7: My financial situation
The following information provides us with an indication of your financial situation. We’ll use this information to establish a credit limit for your ANZ Credit Card. MY ASSETS MY LIABILITIES MY INCOME- Before Tax MY EXPENSES (If you own them jointly, please give the total estimated value) (Monthly) (Monthly) Cash and Term Deposits: Other Investments: Real Estate I own: Other Assets:
(eg your car or shares)
$ $ $ $
Overdrafts: Loans/HPs: Credit/ Store Cards: How many do you have?
$ $ $
Monthly Salary: Income from Rental Properties: (your share of) Any Other Income:
(your share of)
$ $ $
Mortgage Payments:
(your share of) (your share of) (your share of)
$ $ $ $
Other Loans/HPs: Credit/Store Cards: Rent/Board:
$
Please attach a copy of proof of income. If you’re self-employed, please provide copies of your last two years’ balance sheets or annual accounts.
(your share of)
Section 8: Credit Card Repayment Insurance (optional)
Do you want ANZ Credit Card Repayment Insurance? Yes
No
You must be between 18 and 99 years of age to be eligible for ANZ Credit Card Repayment Insurance. Your premium is 79 cents for every $100 owing (or part thereof) at the monthly statement date. Your premium will be automatically charged to your credit card account. Terms, conditions and exclusions are set out in the ANZ Credit Card Repayment Insurance Policy brochure, which will be sent to you. ANZ Credit Card Repayment Insurance is underwritten by ING Insurance Services (NZ) Limited. No member of the ANZ National Bank group or the ING group guarantees ING Insurance Services (NZ) Limited or any products issued by it.
Section 9: Transferring money from another credit card (optional)
Please transfer the debit amount below from my non-ANZ credit card to my new ANZ credit card account. I understand that ANZ may choose to transfer less than the nominated amount if it is greater than 95% of the credit limit approved by ANZ. I understand that if I want to close my non-ANZ credit card, I’ll have to contact the issuer of the card to arrange closure. For full ANZ balance transfer terms and conditions, please refer to ANZ’s Credit Card Terms and Conditions brochure. Amount to transfer: $ This card is issued by: (eg BNZ, ASB, Westpac) The non-ANZ Credit Card number is: The name on the card is:
Section 10: Personal information and declaration
Cardholder declaration In this application ANZ is ANZ National Bank Limited. Qantas is Qantas Airways Limited ABN 16 009 661 901. The Scheme is the Qantas ANZ Visa Rewards Scheme. Points are Qantas Frequent Flyer points. Points Providers means any person, business or company who agrees to provide Points under the Scheme. Personal Information You understand and authorise that the information received from you will be securely held by ANZ and, if you have applied for ANZ Credit Card Repayment Insurance, ING Insurance Services (NZ) Limited (ING) and may be accessed and corrected under the Privacy Act 1993. This information may be used by ANZ or ING to: > consider your application for facilities, products or services now or in the future > administer, manage and monitor any facilities, products or services provided to you > conduct market research, data processing and statistical analysis > provide you with information about other facilities, products or services including selected third party products or services (unless you disagree). ANZ or ING may disclose information about you to: > its related companies (as defined by the Companies Act 1993), agents or contractors for the above purposes > credit reference agencies for the purpose of obtaining a credit report on you and debt recovery or credit reference agencies if you default on any obligations to ANZ or ING. Those credit reference or debt recovery agencies may retain that information and provide it to their customers who use their credit reporting services. > Qantas, its related companies (as defined by the Companies Act 1993), its agents or contractors who may use and disclose your information for the administration of the Scheme, the performance of services relating to the Scheme and planning, research, promotion and marketing of products and services of ANZ, Qantas and any Points Provider. ANZ or ING may obtain information and make such enquiries about you as ANZ or ING considers warranted from any source including its related companies (as defined by the Companies Act 1993) and credit reference agencies for the above purposes. DECLARATION I certify that the information contained in this application is true and complete. I acknowledge that ANZ may cancel or decline my credit card if any of the information provided by me is incorrect. I understand that this application is subject to ANZ Credit Card Terms and Conditions, the ANZ Visa Platinum Rewards Programme Terms and Conditions, and the Qantas ANZ Visa Reward Terms and Conditions. I agree to be bound by these terms and conditions, copies of which I will be sent if my application is accepted or which I can obtain from any ANZ branch. I understand that ANZ will charge a fee to my Credit Card account. I am aware that I can obtain details of current fees by requesting a copy of the ‘Credit Card Fees and Charges’ brochure from any ANZ branch. I certify that I, the principal applicant, have reached 18 years of age. I certify that I, the additional applicant, have reached 16 years of age. I certify that I am not an undischarged bankrupt, or liable under any proceedings under the Insolvency Act 1967 or the Insolvency Act 2006 (as amended).
I do not want to receive information about opportunities for further services and products.
X
Principal applicant’s signature:
X
Additional applicant’s signature:
D
D
M
M
Y
Y
Y
Y
Date of application:
Section 11: For new ANZ customers
Please include a copy of one item from List A and one from List B for both the Principal Applicant and Additional Applicant as proof of identification. List A Current : Passport, NZ Driver Licence, photo credit card. List B Most recent: Bank statement, debit card, credit card, community services card, club or society membership card.
Section 12 : What to do next?
For existing ANZ customers: Complete all relevant sections, attach proof of income (for Principal Applicant only) and send to ANZ Credit Card Application, Freepost 92659, Private Bag 39802, Wellington Mail Centre, Wellington. For new ANZ Customers: This application can be submitted to any ANZ branch. You will need to bring in proof of income (for Principal Applicant only) and two original forms of identification (for both the Principal and Additional Applicant to bring) to be sighted by a bank officer. If a branch is not convenient, post your application along with proof of income and a certified copy of two forms of ID for both Principal Applicant and Additional Applicant to ANZ Credit Card Application, FreePost 92659, Private Bag 39802, Wellington Mail Centre, Wellington. If posting, a Justice of the Peace or Solicitor will need to sign, date and place a daytime contact phone number on a copy of each piece of identification submitted. Thank you for applying for an ANZ credit card – we’ll be in touch soon.
BANK USE ONLY
CIS number: Principal Applicant ID: Additional Applicant ID:
A A
Branch number:
Staff number:
B B
DDI:
0
[BRANCH STAMP]
I confirm I have identified the Principal Applicant and the Additional Applicant Sales officer’s name:
I confirm I have verified the Principal Applicant’s income. Signature X
Date received
ANZ, part of ANZ National Bank Limited