Auto Lease Application Form

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Hitachi Capital Asia Pacific
Automobile Lease Application Form
□ Corporate
□ Consumer □ Direct Consumer
My Dealer Details
Dealer’s Declaration
I confirm that all the information provided in this application are true and correct and that
Dealer’s Stamp
we have verified the identities of the applicant(s) against their relevant documents.
Signature / Name / NRIC of Salesperson
About Myself
□ Applicant
□ Guarantor (please tick one)
Main Applicant
NRIC/Passport/ACRA No:
Full Name as per NRIC / Passport / Company
Date of Birth / Date of Incorporation
Marital Status: □ Single / Divorced □ Married □ Others : _______________
Entity Type: □ Pte Ltd □ SP □ Partnership □ LLP
Residency Status: □Singaporean □Singapore P.R
□ Foreigner, Nationality ______________________
No. of Dependents
Family Size:
Residential Address / Registered Address
Delivery Address(If Different From Given Address)
S(
)
S(
)
Property Ownership: □ Owned & fully Paid □ Owned & Mortgaged
□ Rented
Property Type:
Length of stay:
□ 3 / 4 / 5 / Exec □ EC □ Private □ Others:
□ Live with Parent’s □ Employer’s □ Others: ___________
Office:
Contact Numbers (Min. 2)
Home:
Mobile:
□ ‘O’ / ‘A’ Levels
□ Primary Level
□ Diploma
□ Degree / Post Graduate
□ Technical
□ Masters / Doctorate
□ Others:
Does Applicant Possess A Valid Singapore Driver’s License? □ Yes□ No
Class: □ 3 □ 3A □ Others: ____
Driving Experience : ____(Yrs)
□Yes □ No
Is Applicant the main driver of the vehicle?
Others: Relationship: __________________
Driving Experience : ____(Yrs)
Has Applicant been refused Motor Insurance or has Applicant’s Insurance Policy been cancelled and/or had specials conditions?
Current NCD Entitlement
(if
□ Yes □ No
any) :
%
□ Main Named Driver (Tick if Applicant is not the Main Driver)
Name of named driver (other than applicant, if applicable) :
Driving Experience : ____(Yrs)
Name of named driver (other than applicant, if applicable) :
Driving Experience : ____(Yrs)
My Employment Details
Industry/Business Type: □ Government & Education □ Finance & IT □ Health □ Trade
Name of Company
□ Manufacturing & Construction □ Services □ Agriculture □ Others: _______________
Job Title
Length of Services:
Yrs
Mths
Current Position: □ Senior Management / Professional
Address
□ Manager / Executive □ Civil Servant / Office Staff / Skilled Worker □ Sales / Services
□ Owner Business □ Driver / Worker / Guard
S(
)
□ Retired, Student or Home Maker □ Others :___________________
Gross Monthly Salary
S$
Other Income
S$
Source Other Income:
My Financial Details
Mthly Financial Commitments
Cards:__________________ Loans: ________________ Others: _______________
My Vehicle Details
□ New
□ Used
Vehicle Description
Make
Model
Colour
Chassis No.
Engine No.
Original Reg. Date :
Reg. No.
My Finance Request
Annual Motor Insurance □ Yes □ No
□ Yes □ No
Your rental payment will be:- (subject to prevailing GST)
Tyres Replacement
Annual Road Tax Licence □ Yes □ No
24hours Emergency Asst □ Yes □ No
1. Monthly Rental : $ ________________ x __________ months
Scheduled Maintenance □ Yes □ No
2. Initial Payment (if any) : $ ______________________
Towing/Recovering in Singapore & Malaysia
□ Yes □ No
□ Yes □ No
Replacement Vehicle
Security Deposit
: $ ______________
Collision Damage Waiver/Excess
Expected Delivery Date
: ________________________
Mileage Limit _______________km
□ Yes □ No
Declaration / Authorization
By signing below, I confirm the above information given by me in this application is true and accurate, and I have not willfully withheld and material fact. I will pay all rentals due to Hitachi
Capital Asia Pacific Pte Ltd (“HCAP”) by GIRO if my application is approved. I confirm that I am currently not under any legal proceedings by creditors. I understand that HCAP may reject
my application at its sole discretion without assigning any reasons/explanation whatsoever. I agree that HCAP reserves the right to ask for additional documents / information from
me in reviewing and assessing my application, and if any of the above information or supporting documents provided in connection to my application are found to be false after my
application has been approved, HCAP may revoke or void the approval previously granted to me.
I hereby authorize and give consent to HCAP to conduct credit checks on me as you may deem fit including but not limited to checks with credit bureau or reference agency for the purpose of
assessing my credit worthiness, and also to disclose to parties or persons any information whatsoever given by me in connection with this application and / or in connection with all previous and
current transactions between HCAP and me as HCAP may deem necessary without any liability or notice to me.
I further authorize HCAP to purchase the above vehicle for the sole purpose of leasing it to me after my lease application is approved by HCAP. In the event that I cancel or withdraw my vehicle
lease application after HCAP has already purchased the vehicle, I shall upon demand reimburse and pay HCAP the purchase price of the vehicle in full and/or shall be liable to pay for any losses
or damages suffered by HCAP arising directly or indirectly from my decision to cancel or within the lease application.
Personal Data Protection
Pursuant to the requirements of the Personal Data Protection Act 2012 (the “Act”),I hereby confirm to HCAP the following :
1.
I consent to HCAP in enrolling me into any product survey and/or allowing me to be kept informed of promotions, new services and products offered by HCAP from time to time via
the following channels selected by me below even if my contact number(s) provided to HCAP are registered with the "DO NOT CALL" Registry :
SMS / MMS
Fax
Voice call
Direct mail
Email
2.
I have read, understood and accepted the terms and conditions set out in HCAP's Privacy and Data Protection Policy found at
and fully agree to HCAP collecting, using, disclosing, processing and/or transferring my personal data for the purposes set out in the HCAP's Privacy and Data Protection Policy and
that all terms and conditions set out in Privacy and Data Protection Policy are binding on me.
_____________________________________
_____________________
Stamp/Signature of Applicant/Guarantor
Date
Hitachi Capital Asia Pacific Pte Ltd 111 Somerset Road #11-05 Singapore 238164
HCAP/AL/ Mar 2015 ver.3
Tel: 6734 1222 Fax: 6733 4887

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