Own Your First
Home From
5% Deposit

Assessment Form

Applicant

My Details

Title
Surname
First Name
Phone (home)
Phone (work)
Mobile
Email *
Date of Birth
Number of Dependants

Current Address

Street Address
Suburb
City
Post Code
Time In Home

My Income

Employer
Role
Time With Employer
Type of Income
Gross Income Per Annum ($)
Net Pay ($)
Net Pay Per

Other Income Please List Below

What Is The Income
Amount ($)
Per
What Is The Income #2
Amount #2 ($)
Per #2
What Is The Income #3
Amount #3 ($)
Per #3
What Is The Income #4
Amount #4 ($)
Per #4

Co-Applicant

My Details

Title
Surname
First Name
Phone (home)
Phone (work)
Mobile
Email
Date of Birth
Number of Dependants

Current Address

Street Address
Suburb
City
Post Code
Time In Home

My Income

Employer
Role
Time with Employer
Type of income
Gross Income per Annum ($)
Net Pay ($)
Net Pay per

Other Income Please List Below

What Is The Income
Amount ($)
Per
What Is The Income #2
Amount #2 ($)
Per #2
What Is The Income #3
Amount #3 ($)
Per #3
What Is The Income #4
Amount #4 ($)
Per #4

My Assets (What I own)

Cash In The Bank ($)
Value of Shares ($)
Value of Vehicle(s) ($)
Value of Vehicle(s) #2 ($)
Value of Vehicle(s) #3 ($)
Value of Boat ($)
Value of Furniture and Effects ($)
Value of Kiwisaver ($)
Value of Other Superannuation ($)

All Other Assets Please List Below

What Is It
Value ($)
What Is It #2
Value #2 ($)
What Is It #3
Value #3 ($)
What Is It #4
Value #4 ($)

My Debts (What I owe)

Overdraft

Loan(s) and Hire Purchase

What Was It For
Lender
Amount Owing ($)
Amount Paid ($)
Per
What Was It For #2
Lender #2
Amount Owing #2 ($)
Amount Paid #2 ($)
Per #2
What Was It For #3
Lender #3
Amount Owing #3 ($)
Amount Paid #3 ($)
Per #3
What Was It For #4
Lender #4
Amount Owing #4 ($)
Amount Paid #4 ($)
Per #4

Credit and Store Cards

Limit
Who Is It With
Amount Owing ($)
Amount Paid ($)
Per
Limit #2
Who Is It With #2
Amount Owing #2 ($)
Amount Paid #2 ($)
Per #2
Limit #3
Who Is It With #3
Amount Owing #3 ($)
Amount Paid #3 ($)
Per #3
Limit #4
Who Is It With #4
Amount Owing #4 ($)
Amount Paid #4 ($)
Per #4

Student Loan

Amount Owing ($)
Amount Paid ($)
Per
Amount Owing #2 ($)
Amount Paid #2 ($)
Per #2

All Other Debts Please List Below

What Is It For
Amount Owing ($)
Amount Paid ($)
Per
What Is It For #2
Amount Owing #2 ($)
Amount Paid #2 ($)
Per #2
What Is It For #3
Amount Owing #3 ($)
Amount Paid #3 ($)
Per #3
What Is It For #4
Amount Owing #4 ($)
Amount Paid #4 ($)
Per #4
Any known issues affecting your credit

My Payments

Current Rent Payments ($)
Per
Child Support ($)
Per
Personal Insurance ($)
Per
Contents Insurance ($)
Per
Vehicle Insurance ($)
Per
Vehicle Insurance #2 ($)
Per #2
Vehicle Fuel/Rego/Running ($)
Per
Public Transport ($)
Per
Power/Gas ($)
Per
Landline Phone/Data ($)
Per
Mobile Phone/Data ($)
Per
Subscriptions (Sky, Gym, Social Club, etc) ($)
Per
Food and Household ($)
Per
General ($)
Per

All Other Expenses Please List below

What Is It For
Amount Paid ($)
Per
What Is It For #2
Amount Paid #2 ($)
Per #2
What Is It For #3
Amount Paid #3 ($)
Per #3
What Is It For #4
Amount Paid #4 ($)
Per #4

Regular Savings Calculation

How much do you regularly contribute to savings? ($)
Per

Verification

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Captivate Homes

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