Personal Statement of Financial Position

1

Applicant details

Applicant

First names and surname

Date of birth

Smoker status

Type of residence

Residential address

Duration at address

No. of dependants

Previous address (if < 2 years)

Duration at previous

Age(s) of dependants

Occupation

Years in industry

Business / employer's name

Years with employer

Nature of business

Years trading

No. of employees

Telephone (home / mobile)

Telephone (work)

Email

Joint applicant

First names and surname

Date of birth

Smoker status

Type of residence

Residential addressSame as applicant above

Duration at address

No. of dependants

Previous address (if < 2 years)

Duration at previous

Age(s) of dependants

Occupation

Years in industry

Business / employer's name

Years with employer

Nature of business

Years trading

No. of employees

Telephone (home / mobile)

Telephone (work)

Email

2

Finance details

What are you borrowing for?

Loan term required (months / years)

How much would you like to borrow?

3

Home loans — deposit

How much deposit do you have, and what is its source? (Evidence of deposit is required.)

Source	Amount
Total deposit

4

Income

Monthly income

Source	Applicant	Joint applicant
Salary / wages (before tax)
Rent received
Interest / dividends
Self-employed / business incomeIncluding drawings & net trading surplus. Latest financials required.
Other regular incomePart-time, commission or benefits.
Sub-totals

Combined total gross monthly income

Gross annual income & KiwiSaver

Total annual income — applicant

Total annual income — joint applicant

Current KiwiSaver rate — applicant (%)

Current KiwiSaver rate — joint (%)

Future KiwiSaver rate — applicant (%)

Future KiwiSaver rate — joint (%)

Student loan balance — applicant

Student loan balance — joint

KiwiSaver balance — applicant

KiwiSaver balance — joint

Is your income likely to change over the next 12 months?

NoYes

Security

Does this loan involve a guarantor?

NoYes

Guarantor consented to disclosure?

NoYes

Address of property

Address suggestions powered by Google

Address(es) of additional security property(ies)

Shareholders with ≥ 25% share in the business

Committed drawings (12 mo) — shareholder salary

Committed drawings (12 mo) — dividend / profit distribution

Committed, non-debt-funded business capital expenditure (next 12 mo)

Is business net profit before tax expected to decrease over the next 12 months?

NoYes

5

Household commitments

Enter each amount at whatever frequency suits — the monthly equivalent and totals calculate automatically. Combine amounts for a joint application.

Monthly fixed financial commitments

Commitment	Amount	Frequency	≈ / month
Rent or board payments
Hire purchase payments
Body corporate fees
Child support / maintenance
Lease / ground rent
KiwiSaver
Total fixed commitments (monthly)

Monthly expense outgoings

Expense	Amount	Frequency	≈ / month
Household
FoodGroceries, food, meat and vegetables.
UtilitiesPhone (landline/mobile), power, internet, gas, water.
RatesOwner-occupied property rates.
TransportParking, fuel, WOF, rego, servicing, public transport.
Ongoing household expensesMaintenance, lawnmowing, cleaners.
Personal
ChildcareDaycare, after-school care, babysitting, au pair.
Healthcare / medicalDoctors, dentists, prescriptions, physio.
Personal care & clothingClothes, footwear, pet care, hairdressing.
Public educationPublic school fees / donations.
Private educationPrivate school fees / donations.
Insurance — auto-filled from Section 6 (Insurance in place) below
House & contents insurancePremiums for house and contents.
Vehicle insuranceCars, boats, trailers, motorcycles, campervans, etc.
Health / medical / funeral
Life & disability insuranceLife, income, disability, trauma.
Other non-discretionary
Other non-discretionaryRegular commitments you're unwilling to give up (gym, donations, payments to overseas family).
Details of other non-discretionary
Total monthly expense outgoings

6

Insurance in place

Life & health insurance — current cover

Person covered	Insurer / provider	Cover type	Cover amount / details	Premium	Frequency

Yes — review my life & health insurance. Please review the cover listed above as part of my advice, alongside any new recommendations.

Fire & general insurance — current cover

Insurer	Policy type	Property / vehicle covered	Premium	Frequency

Sum insured figures from the Cordell Sum Sure calculator are automated rebuild-cost estimates provided as guidance only — not advice or a valuation. Please confirm the appropriate sum insured with your insurer or our F&G partner.

Yes — review my fire & general insurance. Please refer my details to Agile Strategy's F&G partner (Blanket) for a free comparison quote on the cover listed above.

7

Liabilities & guarantees

Are you currently in arrears on any credit commitment?

NoYes

Type	Facility	Institution	Balance	Limit	Payment	Freq.
Totals

Shared liability allocation (if joint / shared)

Expense allocation — applicant (%)

Expense allocation — joint (%)

Other arrangement

Commitment / liability — applicant (%)

Commitment / liability — joint (%)

Other arrangement

Guarantee liabilities

Are you currently acting as guarantor for any loan?

NoYes

Serviced from your personal income?

NoYes

Type	In favour of	Description	Amount
Totals

Do you currently have any tax arrears or commitments?

NoYes

8

Assets

Real estate property

Description	Value (NZ$)	Basis

Deposits & investments (incl. KiwiSaver)

Description	Value (NZ$)

Life assurance / superannuation

Description	Value (NZ$)

Motor vehicle (incl. make & year)

Description	Value (NZ$)

Other vehicles (boat, caravan, trailer)

Description	Value (NZ$)

Furniture / personal effects

Description	Value (NZ$)

Livestock

Description	Value (NZ$)

Other

Description	Value (NZ$)

Total assets

Net position — total assets less total liabilities

9

Privacy & information disclosure

Who is collecting your information. This information is collected and held by Agile Strategy Ltd (Newton Financial Solutions), Financial Advice Provider FSP1004382, of 14 Francis Street, Grey Lynn, Auckland 1021, for the purpose of providing you with financial advice and assessing, arranging and submitting your application for credit to one or more lenders on your behalf, and to meet our obligations under the Anti-Money Laundering and Countering Financing of Terrorism Act 2009.

Who we may share it with. With your authority, we may disclose your personal information to lenders and their mortgage or credit insurers, to credit reporting and reference agencies, and to other parties where reasonably necessary to assess, arrange or administer your lending. We hold your information securely and use it only for the purposes described above or as permitted by law.

Information we collect about you from others (IPP 3A). In the course of preparing and submitting your application we may also collect personal information about you from sources other than you — for example credit reporting agencies, your bank, employer, accountant, or a proposed lender. This notice makes you aware of that indirect collection, the purposes above, the intended recipients, and that Agile Strategy Ltd (Newton Financial Solutions) is the agency collecting and holding it.

Your rights. Under the Privacy Act 2020 you may request access to, and correction of, the personal information we hold about you. To do so, contact our Privacy Officer at support@agilestrategy.co.nz or 021 888975. Providing this information is voluntary, but if you choose not to provide it we may be unable to progress your application.

Customer authorisation — I/we confirm and authorise that:

I/We authorise Agile Strategy Ltd (Newton Financial Solutions), and any lender it submits my/our application to, to collect, use and exchange any personal information relevant to my/our credit application — including a credit and fraud check — held by credit providers, credit reporting agencies, and any previous or current employer regarding my/our employment history and income. I/We authorise the relevant credit reporting agency to hold and use my/our personal information to provide its credit reporting services, and to provide that information to its customers when they use those services. I/We authorise the use of a credit reporting agency in future for purposes related to the provision of credit to me/us; the giving of information about any default in my/our payment obligations to that agency; and the agency giving that information to its other customers. I/We are not, and have not been, an undischarged bankrupt, and will advise our adviser and any lender should I/we be adjudicated bankrupt. I/We understand the information in this Statement of Financial Position may be used as the basis of a credit application, and warrant that true and complete disclosure has been made. I/We acknowledge that providing incorrect information may result in the application being declined.

10

Signatures

Applicant — name

Joint applicant — name

Applicant — signature

Joint applicant — signature

Date