Department

New Used

Transaction Type

Instalment Sale Lease Rental

APPLICANT DETAILS

Applicant Type

Individual Applicant Sole Proprietor Surety / Co Debtor

Citizenship

South African Foreign

ID/Passport Number

Title:

Mr Dr Miss Mrs

Initials:

Full Name(s):

Surname:

Gender

Male Female

Graduate

Yes No

Telephone:

Mobile:

Email Address:

APPLICANT SPOUSE INFORMATION

Name:

ID/Passport Number:

Mobile No:

SUPPORTING DOCUMENTS

To be submitted with application

• ID DOCUMENTChoose File
• DRIVERS LICENCEChoose File
• PROOF OF ADDRESSChoose File
• 3 MONTHS PAYSLIPChoose File
• 3 MONTHS BANK STATEMENTChoose File

MARITAL STATUS

Marital Status:

Single Married Divorced Widowed

Marital Contract:

ANC COP Other

Date of Marriage:

RESIDENTIAL ADDRESS

Home Address:

Town/City:

Postal Code:

Postal Address:

Period at Residential Address:

EMPLOYMENT DETAILS

Type of Industry:

Occupation:

Company Name:

Address:

Suburb:

Telephone Number:

Fax Number:

Period at Employer:

INCOME

Gross Income:

Net Income:

Additional Income:

Bank:

Type of Account:

Account Number:

DEBT PAYMENTS

Home Loans:

Financed by:

Vehicle Loans:

Personal Loans:

Revolving/Credit Card:

LIVING EXPENSES

Rates, Water and Electricity:

Telephone and Mobile:

Rent and Accommodation:

Education and School Fees:

Transport and Petrol:

Groceries, Food:

Clothing Accounts:

Policy Insurance Repayments:

Furniture Accounts:

Overdraft Repayments:

ADDITIONAL CONTACT
(RELATIVE OR FRIEND)

Title:

Mr Dr Miss Mrs

First Name:

Surname:

Relationship:

Telephone Number:

Address:

Add Signature

Save Signature

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