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82 Marico Street, Sinoville, Pretoria, 0129

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Vehicle Finance

Personal Details:

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Title

Full Names

ID Number

Initials

Surname

Dependants

Gender

Marital Status

Date Married

Tel (H)

Tel (W)

Cell No.

Fax

Email

Home Address

Postal Address

Previous Address

Spouse Names

Next of Kin

Address

Period

Code

Period

Spouse ID No.

Relationship

Tel

Bond Details:

Bond Holder

Outstanding

Date Purchased

Registered

Rent Per Month

Employer Status:

Employer

Occupation

Address

Tel

Salary Date

Previous Employer

Spouse Employer

Occupation

No. Of Years

No. Of Years

No. Of Years

Bank Details:

Bank Name

Branch Name

Branch Code

Acc. Holder

Acc. Number

Acc. Type

Trade References:

Branch

Account No.

Paid Up/Current / To be settled

Instalments

Ethnic / Language:

Race

Language

Personal Application:

Salary Details

Basic Monthly (Excl.car Allowance)

Car Allowance

Total Salary (Basic & Car Allowance)

Monthly Commission

Net Take Home Pay

Income other than Salary / Wages  **

Sources of other Income  **

Total Monthly Household Income (Net Salary & Other)

OWN

SPOUSE

Household Expenses Per Month:

Bond Repayment / Rent

Rates, Water & Electricity

Vehicle Instalment (Excluding settled)

Personal Loan Repayments

Credit Card Repayments

Furniture Accounts

Clothing Accounts

Overdraft Repayments

Policy / Insurance repayments

Telephone Repayment

Transport costs

Food & Entertainment

Education Costs

Maintenance

Household Expenses

Other

Total Monthly Household Expenses

Household Surplus / Disposable Income

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Amount

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If you have signed Surity or Co-Debtor, Please indicate the full amount Outstanding:

I Confirm that:

A. I am not a minor.

B. I have never been declared mentally unfit by a court.

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 am not under sequestration.

H. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.

I. If any of the above is incorrect, give details:

I Agree to the above


Declaration by Client

I hereby grant the Credit Provider the right to communicate with me throught any electronic/written media or verbally in order to make available to me, their product offering

I hereby grant the Credit Provider the right to increase my Credit Limit once every year to accommodate ant Value Added Products needed and requested by me.

I hereby give consent to the Credit Provider to make enquiries about my credit record with anty credit agency and to obtain whatever information on me they might require to process the application. I also give consent to the Credit Provider to share my payment behaviour with any credit agency.

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