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012 342 8571

Finance Application

    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