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Finance Application

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Application for Installment Finance

Personal Details
Title *
Initials*
Surname*
ID No *
Full Names *
Dependants
Gender
Marital Status *
Date Married
Home Address
Period
Tel (H) *
Cell *
Fax
Tel (W)
Email *
Postal Address *
Code
Previous Address *
Period
Spouse Names
Spouse ID
Next of Kin
Relationship
Address
Tel
Bond Details
Bond Holder
Amount Outstanding
Property Value R
Installment /M
Purchase Price
Date Purchased
Registered
Renting R
Employer Details
Employer *
Occupation *
Employers Address *
Tel *
No of Years
Salary Date *
Previous Employer
No of Years
Spouse Employer
No of Years
Tel
Occupation
Salary Details
  Own Spouse Other
Basic Monthly *(excl Car Allow)
Car Allowance
Total Salary Basic & Car Allow
Monthly Commision
Net Take Home Pay
Income other than Salary (Net Income)
Sources of other income
Bank Details
Bank Name *
Branch *
Branch Code *
Name of Account Holder *
Account number *
Account Type
Household Income
 
Own
Spouse
Bond Payment / Rent
Rates, Water & Electricity
Vehicle Installments
Personal Loan Repayments
Credit Card Repayments
Furniture Accounts
Clothing Accounts
Overdraft Repayments
Policy / Insurance Payments
Telephone Repayments
Transport Costs
Food & Entertainment
Education Costs
Maintenance
Household Expenses
Other
Total Monthly Household Expenses *
Household Surplus / Disposable income *
Are You Currently Liable As:
Specify Details
If you have signed Surety or Co-Debtor Please Indicate the Full Amount Outstanding
Vehicle Details
Make
Model
Variant
Year
Price
Mileage

Terms & Conditions

I confirm that:

(a) I am not a minor.

(b) A court has never declared me mentally unfit.

(c) I am not subject to an Administration Order.

(d) I do not have any current application pending for debt restructuring or alleviation.

(e) I do not have any current debt re-arrangement in existence.

(f) I have not previously applied for a debt re-arrangement.

(g) 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, state which and give details:

I would like to be included in any Telemarketing Campaign

I would like to included in any marketing list that you may sell or distribute

I would like to included in any mass distribution of emails or SMS messages

* 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 bereau.

* I consent to this Credit Provider reporting 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.

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