Life Investment Corporation

Applicant's Information for Finance.

Please complete the following application form to apply for finance through Eurofinance. Note: All fields marked with an asterisk (*) are required to enable us to start processing your application. Alternatively, download our application form here, manually complete it, then post or fax back to us.

I/we authorise LIC NZ to provide this information: To any person for the foregoing purposes; to any employees and agents of LIC NZ and/or any other person, in any ordinary course of business, for any of the foregoing purposes; To credit agencies for the purpose of maintaining proper or effective records. I/we acknowledge that if i/we do not provide all or any part of the information requested on this application form, my/our application for finance may be declined. I/we further acknowledge that pursant to the Privacy Act 1993, I/we have a right of access to information collected by LIC NZ about me/us and to request that this information be corrected. The information will be held at the office of LIC NZ, 12 Britton Avenue,Mt Roskill Auckland or the registered offices of any party nominated by LIC NZ. *LIC NZ and other associated third parties