Finance Application

Welcome to our finance application section.

You can fill in the online form below and we will submit your application for approval promptly.

Should you feel it is more secure to do so, feel free to download the printable form, fill it in and fax it back to us at: 086 650 8012

Click Here to download the printable form (.pdf)

We need:

Valid Drivers Licence copy
RSA Barcoded ID copy
Proof of physical address – water/lights accountCompleted e-application
Latest proof of income e.g. payslip

Personal Details

Title

Surname

ID No:

Full Names

Initials

Dependants

Male

Female

Maried

ANC

COP

Single

Widowed

Date Married

Tel: (H)

Tel: (W)

Cell:

Fax

E-Mail

Home Address

Period

Postal Address

Code

Previous Address

Period

Spouse Names

Spouse ID

Nex of Kin

Relationship

Address

Tel

Bond Details:

Bond Holder

Outstanding

Date Purchased

Registered:

Own Name

Spouse

Renting

Employer Status:

Employer

Occupation

Employer Addres

Tel:

No.of Years

Salary Date

Previous Employer

No.of Years

Spouse Employer

No.of Years

Tel:

Occupation

Bank Details:

Bank Name

Branch Name:

Branch Code

Name of Account Holder

Account No.

Credit Card

Savings

Transmission

Current

Trade Reference:

Branch	Account No.	Instalments	Paid up / Current / To be Settled

Ethnic Group:

African

Coloured

Indian

White

Language Preference

English

Afrikaans

Zulu

Sotho

Other

Personal Application:		Own		Spouse
Salary Details	R		R
Basic Monthly (Excl.car Allowance)	R		R
Car Allowance	R		R
Total Salary (Basic & Car Allowance)	R		R
Monthly Commission	R		R
Net Take Home Pay	R		R
Income other than Salary / Wages**	R		R
Sources of other Income**	R
Total Monthly Household Income (Net Salary & Other	R

Household Expenses per Month

Bond Repayment / Rent

Rates, Water & Electricity

Vehicle Instalment

(Excluding those to be 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	R
Household Surplus / Disposable Income	R

Are you Currently Liable as:

Surety

Guarantor

Co-Debtor

Specify Details

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 unde 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:

Decleration by Client:

	Y	N
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, teir 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.