Application for Finance
Introducer Details
Dealership:
Branch:
Quote Reference #:
Sales Person:
Phone:
Email:
Q-
Primary Borrower / Customer 1 Details
Existing customer of CNH Industrial Capital?
Yes
No
If you are a new customer to CNH Industrial Capital we need to sight a current copy of your driver’s licence
Nature of Business:
Company Name:
Trading Name:
Trust Name:
Established Since:
ACN:
ABN:
Trust Type:
Are the beneficiaries of the trust named on the trust deed?
Title:
Yes
No
Surname:
Given Name/s:
Drivers Licence #:
Address:
State:
City/Town:
Mailing Address: (if different to above)
Phone #:
(H)
State:
(W)
Date of Birth:
Expiry Date:
Postcode:
(M)
Email:
Customer 2 Details –
Borrower
Guarantor
Yes
Existing customer of CNH Industrial Capital?
If you are a new customer to CNH Industrial Capital we need to sight a current copy of your driver’s licence
Company Name:
ACN:
Trading Name:
ABN:
Trust Name:
Trust Type:
Yes
Are the beneficiaries of the trust named on the trust deed?
Title:
Given Name/s:
Drivers Licence #:
Address:
City/Town:
Mailing Address: (if different to above)
Phone #:
(H)
Email:
No
No
Surname:
State:
Date of Birth:
Expiry Date:
State:
Postcode:
(W)
Page 1
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042016
Customer 3 Details –
Borrower
Guarantor
Existing customer of CNH Industrial Capital?
Yes
If you are a new customer to CNH Industrial Capital we need to sight a current copy of your driver’s licence
Company Name:
ACN:
Trading Name:
Trust Name:
ABN:
Trust Type:
Are the beneficiaries of the trust named on the trust deed?
Title:
Yes
No
No
Surname:
Given Name/s:
Drivers Licence #:
State:
Date of Birth:
Expiry Date:
State:
Postcode:
Address:
City/Town:
Mailing Address: (if different to above)
Phone #:
(H)
(W)
(M)
Email:
Customer 4 Details –
Borrower
Guarantor
Existing customer of CNH Industrial Capital?
Yes
If you are a new customer to CNH Industrial Capital we need to sight a current copy of your driver’s licence
Company Name:
ACN:
Trading Name:
Trust Name:
ABN:
Trust Type:
Are the beneficiaries of the trust named on the trust deed?
Title:
Given Name/s:
Drivers Licence #:
Address:
City/Town:
Mailing Address: (if different to above)
Phone #:
(H)
Email:
Yes
No
Surname:
State:
Date of Birth:
Expiry Date:
State:
Postcode:
(W)
(M)
Additional information that may support your application
Page 2
No
042016
Statement of Personal
Assets and Liabilities
Accountant and Insurance Broker Details
Accountant Firm:
Email:
Insurance Broker:
Contact Person:
Phone:
Phone:
Customer Name:
Assets
Properties
Value
Rural Properties Name
$
$
$
Non Rural Properties
$
$
Cash at Bank
Livestock
Produce / Crop on Hand
Trade Debtors
Plant / Machinery
Other (please list below)
Total Assets
Mortgage Details
Liabilities
Balance
$
$
$
Mortgage Details
$
$
$
$
$
$
$
Bank Overdraft
Bank Loans (other)
Finance due within 12 months
Chattel Mortgage / Lease
Total Balance Outstanding
$
$
$
$
$
$
Tax Liability
$
0 Total Liabilities
Net Asset Position
$
$
$
0
0
By ticking the box and signing the Privacy Act you are confirming that the information provided is true and correct
TIP: Don't forget to print off the Privacy Act, have it signed and attach it to the return email
along with a copy of your drivers licence
Have questions about our application process?
Simply call our Sales Support team
Once you are ready to submit your application and privacy form, simply save as and
attach to a new email. Alternatively, you can fax it through to us as well.
email. Alternatively you can fax it through to us as well.
1800 807 934
apfinancials@cnhind.com
1800 177 916
www.cnhindustrialcapital.com
Page 3
042016
Privacy Act Authorisation and
Disclosure Form
This part must be read and signed by each individual
and the directors of each company listed in this Finance
Application.
Personal Information: As part of this application CNH
Industrial Capital Australia Pty Limited ABN 71 069 132
396 ("CNHIC”) is collecting personal information from
you. CNHIC will use, disclose and make accessible your
personal information in accordance with its Privacy
Policy, the Privacy Act 1988 and the Australian Privacy
Principles.
We are required to collect personal information about you
not only for the purpose of assessing this application, but
also in order to comply with our obligations as a reporting
entity under the Anti-Money Laundering and CounterTerrorism Financing Act 2006 (Cth). If you do not provide
the information requested or do not give your authority
for the use of the information, CNHIC may decline your
application
CNHIC and Credit Reporting Agencies: You authorise
CNHIC to give to and seek personal information about your
credit arrangements or obtain a consumer or commercial
credit report containing information about you from
any credit reporting agency.
The personal information which CNHIC may give or
seek includes (where applicable):
• your name, sex, date of birth, current address and
last two addresses, current or last known employer
and driver’s licence number;
• the fact that you have entered into or propose to
enter into an agreement with CNHIC and the amount
of credit that you have or will obtain in accordance
with the agreement;
• that you have drawn cheques for $150.00 or more
which have been dishonoured more than once;
• that court judgments and/or bankruptcy orders have
been made against you;
• that you are 60 days or more overdue in making a
payment to CNHIC and that steps have been taken to
recover all or any part of the money that you owe;
and.
• that, in CNHIC’s opinion, you have committed a serious
credit infringement.
You authorise CNHIC to give to and seek credit
reports and other information about your credit
arrangements from:
• credit providers named in any application or
agreement between you or a company of which you
are a director or shareholder and CNHIC; and
• any credit providers that may be named in a credit
report issued by a credit reporting agency.
Your authorisation entitles CNHIC to exchange
information about your credit worthiness, credit
standing, credit history and credit capacity.
Use of your Personal Information: Credit reports and
other personal information CNHIC obtains about you
including your credit arrangements from a credit
reporting agency or credit provider may be used by CNHIC
for the following purposes:
• to assess your application or that of a company of
which you are a director or shareholder;
• to assess whether to accept you as a guarantor
in respect of an application for consumer or commercial
credit;
• to collect payments that are overdue;
• to notify a credit provider if you breach an
agreement with CNHIC;
• to exchange personal information with other credit
providers as to the status of your account where you are
in breach of a contract with a credit provider;
• to assess your credit worthiness or that of a
company of which you are a director or shareholder;
• to allow a credit reporting agency to create a file
about you;
• to administer your account;
• to monitor your performance or compliance or that
of a company of which you are a director or shareholder
under any agreement for sale or supply of goods or
services connected to provision of credit by CNHIC;
• any other purpose permitted or required by law.
People we may Exchange your Personal Information with:
You authorise CNHIC to give to and seek personal
information about you from:
• any person or organisation named by you in the
application or provided by you from time to time;
• your proposed guarantor(s), mortgage insurer(s),
introducers, consultants, brokers or any authorized
dealer, supplier of goods and services;
• CNHIC’s collection agents or an unrelated debt
recovery organisation if you are in breach of any
agreement with:
• CNHIC; or
• CNHIC’s related companies and authorised dealers,
within and outside Australia (“the Group”) which service
your account or any agreement you have with CNHIC.
You also authorise your accountant to release and
disclose your financial information to CNHIC or its agents
and you authorise government authorities which hold
your drivers licence and/or motor vehicle registration
information to confirm your address details to CNHIC or
CNHIC's authorised agents.
Marketing and Product Development: You authorise the
Group to use your personal information to:
• provide financial, administrative and other services
for the purposes of the Group’s business (for
example back-office administration call centre
facilities and mailing services);
• develop a customer profile to enable the Group to
give you better service;
• develop new products, review and analyse products
and customer needs; and
• plan, research, promote and market products and
services that may be supplied by the Group or by
other suppliers, which the Group considers may be
of interest to you by any member of the Group.
You can request that you do not receive direct marketing
communications at any time by opting out below.
Obtaining our Privacy Policy, Accessing and Updating Your
Information: You can request a copy of CNHIC’s Privacy
Policy or obtain access to or update your personal
information by writing to “The Privacy Officer” at CNHIC’s
address on this Privacy Act Authorisation or on your
agreement with CNHIC.
Providing Personal Information about Others: If you
provide personal information about another individual you
agree that you will inform the individual that personal
information about them has been supplied to CNHIC, why it
has been provided and that they can contact CNHIC to
obtain access to or update their personal information or
get a copy of CNHIC’s Privacy Policy.
Continuing Consents and Authorities: CNHIC may use or
disclose this information before, during or after the term
of any agreement you have with CNHIC.
Tick here if you do not wish to receive direct
marketing communication from the Group, its agents or
contractors
Business and / or Investment Purpose Declaration:
You declare that the credit to be provided by CNHIC is to
be applied wholly or predominantly for business or
investment purposes (or for both purposes). By signing
the declaration you may lose your protection under the
Consumer Credit Code.
Primary Applicant - Signature, Print Name and Date
Applicant 3 - Signature, Print Name and Date
Applicant 2 - Signature, Print Name and Date
Applicant 4 - Signature, Print Name and Date
Page 4
042016