ANZ Credit Card application form

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					Credit Card Application
Welcome to your application for an ANZ 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). 1. Introduction
I am: (please tick) 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 who you are with your application – see section 12). Are you a permanent New Zealand resident? My income is over $20,000 per annum. Yes, I have a good credit rating. (ANZ reserves the right to decline applicants who have an unsatisfactory credit history.) Yes No
(If no, you need to call 0800 ANZ 2 YOU, option 0, to see if you are eligible to apply.)

Bank use only

S T B B A T WK S T A F

2. I would like to apply for a: (please tick one)

Low rate card
ANZ Low Rate MasterCard
The current interest rates are available at anz.co.nz

Low fee card
ANZ Visa ANZ MasterCard

Rewards card
ANZ World Visa

The annual account fee for these products is displayed on the Credit Card Terms and Conditions brochure.

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 Widowed Middle Name Last Name

My house/RD number: Suburb:

Street name: (please supply a street address, not a PO Box number): Town/City:

I’ve been living here for: Years Months

My living arrangements: Own my home

Renting

Boarding

Living with my parents

Number of dependent children: I lived there for: Years Months

My previous address (if you’ve been living at your current address for less than two years): My mailing address (if different from home address): My home phone number: My mobile phone number: The name I’d like on my card:

4. Where do you work?
I am: Self-employed Employed by someone else I’ve worked there for: Years Months

My employer’s/My business name: My occupation: My employer’s address: My work phone number:

5. Important security information
Name of my closest relative or friend in NZ (someone who doesn’t live with you): Their address: Their relationship to me: Their phone number:

Security password (This is required as a security measure to assist customer identification):

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

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 (if you own them jointly, please give the total estimated value)
Cash and Term Deposits: Other Investments: Real Estate I own: Other Assets: (eg. your car or shares)

MY INCOME – Before tax (Monthly)
Monthly Salary:

MY EXPENSES (Monthly)

$ $ $ $

Overdrafts: Loans/HPs: Credit/ Store Cards: How many do you have? Other Liabilities:

$ $ $ $ $

$ $ $

Mortgage Payments:
(Your share of)

$ $ $ $

Income from Rental Properties: (Your share of)
Any Other Income:
(Your share of)

Other Loans/HPs:
(Your share of)

Credit/Store Cards:
(Your share of)

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.

Rent/Board:
(Your share of)

8. ANZ Credit Card Repayment Insurance (optional)
I accept ANZ Credit Card Repayment Insurance. (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.

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: The name on the card is: The non-ANZ Credit Card number is:

$
This card is issued by: (eg BNZ, ASB, Westpac)

10. Personal information and declaration
Cardholder declaration In this application ANZ is ANZ National Bank Limited. I understand and authorise that the information received from me will be securely held by ANZ and, if I have applied for ANZ Credit Card Repayment Insurance, by ING Insurance Services (NZ) Limited (‘ING’). I may access and correct this information under the Privacy Act 1993. The information may be used by ANZ and ING to administer, manage and monitor or to consider my application for any facilities, products or services now or in the future. The information may also be used to conduct market research, data processing and statistical analysis. Unless I disagree, the information may also be used to provide me with information about other facilities, products or services including selected third party products or services. ANZ may disclose information about me to its related companies (as defined by the Companies Act 1993), agents or contractors for the above purposes. ANZ may also disclose information about me to credit reference agencies for the purpose of obtaining a credit report on me. Those credit reference agencies may retain that information and provide it to their customers who use their credit reporting services. If I default in any obligations to ANZ, the information about me may be disclosed to, and retained by credit reference or debt recovery agencies. Those agencies may provide that information to their customers who use their credit reporting services. ANZ may obtain information and make such enquiries about me as ANZ 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 and the ANZ World Visa Rewards Programme 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 Terms and Conditions’ brochure from any ANZ branch. I certify that I, the principal applicant, have reached 18 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 and their amendments.

I do not want to receive information about opportunities for further services and products.

PRINCIPAL APPLICANT’S SIGNATURE X

ADDITIONAL APPLICANT’S SIGNATURE X

DATE OF APPLICATION D D M M Y Y Y Y

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.

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:
B B

Staff Number: :

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 MAX2607


				
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posted:12/18/2009
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