APPLICATION FORM
 
 
  Please complete the fields below:
     
  Loan Amount: R
  Preferred Term:
     
  ONLY SELECT THE PRODUCTS RELEVANT TO YOUR APPLICATION
     
  VEHICLE / ASSET FINANCE
  RENT-TO-OWN (Vehicle's)
  SHORT & LONG TERM "CONSOLIDATION" LOANS
  ITC CLEARANCE "REMOVAL OF DEBT REVIEW FLAGS"
  DOUBLE VALUE SIM CARD & AIRTIME
  BRIDGING FINANCE (Pension & House Sales)
  HOME LOANS
  SELL YOUR VEHICLE AND STILL DRIVE IT
  DECLINE OPTION FOR REFERRALS (Mediation, Debt Counselling or Cash Voluntary Surrender.)
     
   
 

PLEASE NOTE: FOR HOME LOANS, VOLENTARY SURRENDER, MEDIATION OR DEBT COUNSELLING YOU WILL NEED TO COMPLETE A DIFFERENT APPLICATION FORM - REQUEST THE CORRECT APPLICATION FROM YOUR BROKER
   
  PERSONAL INFORMATION
     
  Title:
  First Names:
  Surname:
  Initials:
  ID:
  Ethnic Group:
  Physical Address:
  Province:
  Code:
  Period at Address:
  Postal Address:
  Telephone H:
  W:
  C:
  Email:
     
  Marital Status:
     
 
   
  EMPLOYMENT
     
  Employer:
  Employee No:
  Employer Address:
  Occupation:
  Department:
  Start Date:
  Salary Date:
     
  Paid:
     
 
   
  Status:
     
 
   
  Contract End Date:
 
   
  Salary (HR) Person:
 
   
  Salary (HR) Tel no:
 
   
  AFFORDABILITY ASSESSMENT
     
  Gross Salary:
  Nett Salary:
  Other Income:
     
  ONLY LIST THE MONTHLY PAYMENT / INSTALLMENT THAT YOU AS APPLICATION MUST PAY PER MONTH
     
  Personal Loans:
  Clothing Accounts:
  Car Install:
  Credit Cards:
  Furniture Accounts:
  Home Loans:
  Phone Contract:
  Other Phone Exp:
  Rent:
  Municipal Acc:
  Electricity:
  Groceries:
  School Fees:
  Day Care:
  After School:
  Transport / Fuel:
  Insurance:
  Policies:
  Other:
  Other:
  Other:
     
 
     
  Do you have any Garnish Orders on your Payslip?
  If yes how many?
  Do you have any Judgements against your name?
  If yes how many?
     
  Are you:
     
  Under Administration
  Sequestration
  Debt Counselling/Debt Review
   
  SPOUSE / PARTNER
     
  Title:
  First Names:
  Surname:
  ID:
  Occupation:
  Telephone H:
  W:
  C:
  Employer:
  Gross Salary:
     
  1. NEXT OF KIN (NOT LIVING AT THE SAME ADDRESS)
     
  Title:
  First Names:
  Surname:
  Contact Nr:
  Relationship:
  Physical Address:
     
 
     
  Title:
  First Names:
  Surname:
  Contact Nr:
  Relationship:
  Physical Address:
     
  BANKING DETAILS
     
  Name of Bank:
  Branch Name:
  Account Holder:
  Branch Code:
  Account Nr:
     
  Type of Account
     
  Savings
  Cheque
  Mzanzi
   
   
 

MANDATE and AUTHORISATION

I the undersigned, hereby confirm that all data contained on this application from were given freely and are true and correct to the best of my knowledge.

I hereby authorise Loans Acceptable to apply on my behalf for a loan by any registered financial institution they deem fit.

 

Permission to Originate Credit:

I hereby authorizes and agree that the Credit Provider when assessing this application, and at any time during the existence of any loan, may make any reasonable enquiries to confirm any of the details in this application. Such enquiries may include Credit Bureau and Employer Information.

 

Contracting:

I understand that, if credit is approved, I will be contacted directly by the lending institution(s) regarding the terms and conditions of the loan. Loans Acceptable is in no way liable for any damages incurred on the success or otherwise of this application.
   
  I fully understand the content of this application and instruct Loans Acceptable to undertake the mandate as detailed herein.
     
  Yes