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012 342 8571

Finance Application

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VEHICLE DETAILS

MAKE
MODEL
KM
M & M
WARRANTY
LIC & REG
PRICE
DEPOSIT
BALLOON
TERM
INTEREST RATE
SERVICE & DELIVERY

APPLICANT DETAILS

SURNAME
FULL NAMES
ID NUMBER
CELLPHONE
HOME TEL
MARRIEDCOPDIVORCEDANCSINGLE
HOME ADDRESS
POSTAL CODE
POSTAL ADDRESS
CODE
EMAIL
DATE MARRIED

EMPLOYMENT DETAILS

EMPLOYER
EMPLOYERS ADDRESS
WORK TEL
PERIOD EMPLOYED
OCCUPATION
SALARY DATE

BANKING DETAILS

BANK
ACCOUNT NO
BRANCH NAME
CODE
TYPE ACC

SPOUSE DETAILS

SPOUSE NAME & SURNAME
ID NO
CELLPHONE

RELATIVE NOT RESIDING WITH YOU

NAME
SURNAME
TELL NO
RELATION
ADDRESS

INCOME ON PAYSLIP

GROSS
NETT
OVERTIME INCLUDED IN GROSS
COMMISSION INCLUDED IN GROSS
ADDITIONAL INCOME
SOURCE OF ADD INCOME

MONTHLY EXPENSES

BOND / RENT
PERSONAL LOAN
CLOTHING ACCOUNTS
TELEPHONE
EDUCATIONAL
OTHER
RATES WATER AND LIGHTS
CREDIT CARDS
OVERDRAFT REPAYMENTS
TRANSPORT
MAINTENANCE
VEHICLES
FUNITURE ACCOUNTS
POLICY / INSURANCE
FOOD & ENTERTAINMENT
HOUSEHOLD

I confirm that:
* I am not a minor
* I have never been declared mentally unfit by a court
* I am not subject to an administration order
* I do not have any current application pending for debt restructuring or alleviation
* I do not have any current debt re-arrangement in existance
* I have not previously applied for a debt re-arrangement
* I am not under sequestration
* I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act
If any of the above is incorrect give details:
I understand that I will be liable for a monthly service fee. I hereby consent to this Credit Provider making enquiries regarding my credit history with any credit bureau. I consent to this Credit provider the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider's obligation under the National Credit act.
I hereby declare that the information provided by me is true and correct
I hereby also give consent to electronically obtain account statements from financial institutions

Signature of Applicant
Date