FINANCE

Should you require assistance with the application form or don't have your information at hand, please feel free to leave us your details here and our finance specialist will gladly assist you.

Application Type *

Citizenship *

Transaction Type *

ID Number *

Language Pref *

Ethnic Group *

Applicants Details

Title *

Initials *

First Name *

Surname *

Graduate *

Cell Number *

Gender *

Home Address

Email Address *

Date Of occupation *

Suburb

Postal Code *

Employement Details

Company Name *

Occupation

Employee No. *

Type of industry *

Date of Employment *

Business Contact Number *

Address *

Suburb

Postal Code *

Home Ownership

Do You own your property *

Property type

Suburb *

Do You own your property *

Bond amount outstanding

Purchase Price *

Current Price*

If Flexi/Access bond, total facility granted?

Bond/Rental agreement holder

Marital Details

Marital Status *

No. of dependants

Date married

Spouse Name

Spouse Surname

Spouse Income

Spouse ID number

Spouse employer name

Spouse employers address

Application Details

Relationship *

Contact Number *

Relatives address *

First Name *

Surname *

Suburb & postal Code *

Banking Details

Account Type *

Bank Name *

Branch *

Account Number *

Account holder name *

Branch Code *

Income Details

Gross Remuneration *

Monthly Commission *

Car Allowance *

Net Salary *

Income other than Salary / Wages *

Source of Income *

Expense Details

Bond / Rent *

Vehicle Instalments *

Furniture accounts *

Personal Loans *

Clothing Accounts *

Rates, Water and Electricity *

Credit Card Payments *

Overdraft Repayments *

Insurance/Policy Repayments *

Telephone Payment *

Transport Costs *

Food and entertainment *

Education Costs *

Maintenance *

Household expenses *

Other costs *

Totals

Total Monthly Income *

Total Monthly Expenses *

Date Remuneration is received *

Declaration

I am not a minor
I have never been declared unfit by a court
I am not subject to an administration order
I do not have a current application pending for debt review restructuring or alleviation
I do not have any current debt re-arrangement in existence
I have not not previously applied for debt re-arrangement
I am not under sequestration
I do not have any applications pending for credit, nor open quotations as envisaged in section 92 of the national credit act

I would like to be included in any telemarketing campaigns *
Yes
No

I would like to be included in any marketing list you may sell or distribute *
Yes
No

I would like to be included in any mass distribution or SMS messages *
Yes
No

I understand that I will be liable for a monthly service fee
I hereby consent to this credit provider making enquires regarding my credit history any credit bureau
I consent to this credit provider reporting the conclusion of any credit agreement with me to national loans register in compliance with this credit providers obligation under the national credit act
I hereby declare that the information provided by me is true and correct

Applicant full name *

Date completed