Online Application form
 

online application form 
 
  Goods Description:
     
  New
  Used
   
  Goods Description:
     
  Make/Model:
  M&M Code:
  Dealer:
  F&I Contact Person: Jacques Janeke
  Sales Person:
  Tel No:
  Fax No:
     
  Please complete the fields below:
     
  CASH PRICE VAT INCL: R
  Dw3ADD COVER: R
  LICENSE/REG: R
  WARRANTY: R
  DEPOSIT/TRADE IN: R
  PRINCIPLE DEBT: R
 
     
  VATABLE EXTRAS VAT INCL:
     
  INSTALMENT
  LEASE
  CONSUMER LEASE
   
  Please complete the fields below:
 
RADIO/TAPE: RNUMBER PLATES: REXTRAS: RRWC: RTERM/PERIOD:RATE/LINKED:OTHER:OTHER:
     
  PERSONAL DETAILS:
     
  TITLE:
  SURNAME:
  ID NO:
  FULL NAMES:
  INITIALS:
  DEPENDANTS:
 
     
 
     
  MALE
  FEMALE
   
  MARRIED:
     
  ANC
  COP
   
 
     
  SINGLE
  WIDOWED
  DIVORCED
   
  DATE MARRIED:
 
   
  Please complete the fields below:
     
  HOME ADDRESS:
  PERIOD:
  TEL(H):
  TEL(W):
  CELL:
  FAX:
  EMAIL:
  POSTAL ADDRESS:
  CODE:
  PREVIOUS ADDRESS:
  PERIOD:
     
  Please complete the fields below:
     
  SPOUSE NAMES:
  SPOUSE CONTACT NUMBER:
  SPOUSE ID:
  NEXT OF KIN - SURNAME:
  RELATIONSHIP:
  ADDRESS FOR NEXT OF KIN:
  TEL:
 
 
     
  BOND DETAILS:
     
  BOND HOLDER - BONDED VIA "BANK":
  AMOUNT OUTSTANDING: R
  PROPERTY VALUE: R
  INSTALMENT PER MONTH: R
  PURCHASE PRICE: R
  DATE PURCHASED: R
 
     
  REGISTERED:
     
  OWN NAME
  SPOUSE
   
  RENTING/BOARDING: R
 
   
  EMPLOYER DETAILS - AS ON PAYSLIP:
     
  EMPLOYER:
  OCCUPATION:
  TEL:
  EMPLOYER ADDRESS:
  EMPLOYER INDUSTRY TYPE - PROVINCE:
     
  PERIOD:
 
YEARS:MONTHS:
     
  COMPLETE:
     
  SALARY DATE:
  PREVIOUS EMPLOYER:
 
     
  PERIOD:
 
YEARS:MONTHS:
     
  SPOUSE DETAILS:
     
  EMPLOYER:
  TEL:
  OCCUPATION:
     
  PERIOD:
 
YEARS:MONTHS:
     
  BANKING DETAILS - APPLICANT:
     
  BANK NAME:
  BRANCH NAME:
  BRANCH CODE:
  ACCOUNT HOLDER:
  ACCOUNT NUMBER:
     
  ACCOUNT TYPE:
     
  CREDIT CARD
  TRANSMISSION
  CURRENT
   
  TRADE REFERENCE:
 
BRANCH:ACCOUNT NO:INSTALMENTS:PAID UP/CURRENT/TO BE SETTLED:
     
  LANGUAGE PREFERENCE:
     
  ENGLISH(PRIMARY)
  AFRIKAANS(FOR AN EXPLANATORY VERSION)
   
  HOUSEHOLD INCOME DETAILS - APPLICANT (PER MONTH):
     
  BASIC SALARY: R
  VEHICLE INSTALMENTS (EXCLUDING THOSE TO BE SETTLED): R
  CREDIT CARD REPAYMENTS: R
  CLOTHING ACCOUNTS: R
  POLICY/INSURANCE REPAYMENTS: R
  TRANSPORT COSTS: R
  EDUCATION COSTS: R
  HOUSEHOLD EXPENSES: R
  RATES,WATER & ELECTRICITY: R
  PERSONAL LOAN REPAYMENTS: R
  FURNITURE ACCOUNT: R
  OVERDRAFT REPAYMENTS: R
  TELEPHONE PAYMENT: R
  FOOD & ENTERTAINMENT: R
  MAINTENANCE: R
  OTHER - REGULAR PAYMENTS/COSTS PROVIDE DETAILS: R
     
  TOTAL:
 
SUB TOTAL:TOTAL MONTHLY EXPENSES(B):
     
  TOTAL HOUSEHOLD DISPOSABLE INCOME:
     
  TOTAL INCOME(A): R
  LESS TOTAL EXPENSES(B): R
  DISPOSABLE INCOME: R
     
   
  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. The information provided by me in this application is true and correct.
   
  If any of the above is incorrect give details:
 
   
   
  Declaration by client: I hereby grant the Credit Provider the right: i) to increase my Credit Limit once every year to accommodate any Value Added Products needed; ii) to authorise the Credit Provider to make enquiries about my credit record with any credit agency; iii) to obtain whatever information on me they might require to process this application. iv) to apply for additional personal loan if this application for vehicle finance were unsuccessful. I understand that I will be liable for a monthly service fee. I also authorise the Credit Provider to share my payment behaviour with any credit agency and the National Loans Register.
   
 
 
INITIAL:DATE:
     
  I have read and understand the terms and conditions
     
  Yes