Application Form

START HERE.
Please provide me with the following details.

What vehicle are you interested in?

Whould you like to do a Trade-In?

YES

NO

Monthly Expenses.
Please provide us with the following information

Title

Full Name and Surname

Preferred Language

ID Number

Email Address

Primary Number

Work Number

Marital status

Number of dependents

Physical Address

City

State / Province / Region

Postal Code

Number of years living at your current address

Next of kin ( Name & Surname )

Relationship to the next of kin

Next of kin's Phone Number

Next of kin's address

City

State / Province / Region

Postal Code

Monthly Expenses.
Please provide us with the following information

Employment Status

Employed

Self-Employed

Monthly Expenses.
Please provide us with the following information

Bank Name

Type of Account?

Branch Name

Branch Code

Account Number

Monthly Expenses.
Please provide us with the following information

Gross Salary

Net Salary

Do you have an additional income?

YES

NO

Monthly Expenses.
Please provide us with the following information

Are you a Bond Holder?

YES

NO

Monthly Expenses.
Please provide us with the following information

Bond Payment / Rent

Vehicle Installments (Excluding those to be settled)

Credit Card Repayments

Clothing Accounts

Policy / Insurance Repayments

Transport Costs

Education Costs

Household Expenses

Rates, Water and Electricity

Personal Loan Repayments

Furniture Accounts

Overdraft Repayments

Telephone Payments

Food and Entertainment

Maintenance

Other

Total Monthly Household Expenses

Household Surplus/Disposable Income

Declaration by client
I confirm that: I am not a minor. I have never been declared mentally unfit by a court. I confirm that I am not blacklisted. I am not subject to an administration order. I do not have any current application pending for debt restructuring or alleviation. I do not have any current debt re-arrangement existence. I have not previously applied for debt re-arrangement. I am not under sequestration. I do not have applications pending for credit card, nor open quotations as envisaged in section 92 of the National Credit Card Act. I hereby give consent to the credit Provider to make inquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the credit card application and/or application for insurance and to share my payment behavior with any credit card agency.

I hereby agree that all of the above information is true and correct

Yes, I agree

No, I don't agree