High interest enquiry form - Good Shepherd NZ

We need to get some information about you, your income and your expenses.

This information will help our team work out whether you are eligible to go through to a loan application, or whether we can suggest some other support that may be available.

If you live with a partner and share expenses, you will most likely need to complete a joint application.
For more information about why we collection information and what to expect click here.
If you provide incorrect information in this enquiry, we may not be able to help you.
Please confirm*
- I am at least 18 years of age
- I am a NZ resident, citizen or hold a current work or student visa
- I can afford to repay a new loan

To be eligible for our Good Loans your household income must be within our income criteria.
What is your WEEKLY household income AFTER tax? (How much goes into your bank account each week)*
Please enter a number from 250 to 1830.
If your income varies, use the average over the last three months to estimate your income.
Do you live with a partner?*
- Yes
- No
How many dependents (children under the age of 18 in your care) live with you?*
- None
- 1
- 2
- 3
- 4
- 5 or more

I am enquiring about a debt consolidation loan*
- Yes
- No – please go back to complete the Good Loans enquiry form
How much do you want to borrow?*
Please enter a number from 300 to 15000.

Our debt consolidation Good Loans are for up to $15,000. If your debt situation is complex, you may need to work with a financial mentor first.
- I am working with a financial mentor
- I am not working with a financial mentor
Please tell us about your household's current debts
Please exclude student loan and mortgage payments
Creditor name Balance $ Payment $ Frequency
Are you behind on any of these?
- Yes
- No
How will you provide 3 months of current bank statements?*
For more information about why we collect this and what to expect click here.
Using your internet banking you can easily provide bank statements using Credit Sense. For more information about Credit Sense click here.
- I use internet banking and will use Credit Sense
- I do not use internet banking (electronic statements will be required from your bank)
Which banks does your household use/have accounts with?*
- ANZ
- ASB
- BNZ
- First Credit Union
- Heartland Bank
- Kiwibank
- SBS
- The Co-operative Bank
- TSB
- Unity Money (Aotearoa Credit Union & NZCU Central)
- Unity Money (NZCU South & Baywide)
- Westpac
- Other
Tick all that apply
If you select 'other' please specify*
Identity verification*
As part of making a Good Loan application you will need to verify your identity and address. We prefer to use SmartID as a secure, streamlined way to do this.
Click here to read more about this process.
- I have a current NZ passport
- I have a current NZ driver licence
- I do not have either of these

Please complete your personal details so our Unmanageable Debt team can contact you
Name*
First Last
Date of birth*

Day
Month
Year
Gender*
Marital status*
Please specify*
Ethnicity*
Email*
Phone number*
Are your household income and expenses shared?*
If yes, you will need to complete the partner personal details in the section below.
- Yes
- No
Name*
First Last
Date of birth*

Day
Month
Year
Gender*
Ethnicity*
Email*
Phone number*

How did you hear about our service?*
Please specify*
Confirmation information is correct*
- I confirm the information I have provided in this enquiry is correct
Confirmation of understanding and agreement*
- I confirm I have read, understood and agree to the Good Loans client rights and responsibilities statement
Good Loans client rights and responsibilities statement
- I would like to receive Good Shepherd NZ’s newsletter

High interest debt enquiry form

Creditor name	Balance $	Payment $	Frequency