GEMIN MOTORS FINANCE
Email: vincentmalibe30@gmail.com Cell:071-934-6604
Referral (who referred you)
S.A Drivers Licence :
*
Yes
No
Description of vehicle you are looking for :
*
Title :
*
Please Select
Mr
Mrs
Ms
FULL NAME & SURNAME :
*
First Name
Last Name
Date Of Birth :
S.A ID No :
*
Marital Status :
*
Please Select
Single
Married
Widowed
Divorced
Date Married :
E-mail : (if got one)
Cell Phone number :
*
Alternatve Cell number
Applicant Residential Address :
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years at this address :
*
Relative Information :
Next of kin details :
Relative FULL NAME & SURNAME :
*
First Name
Last Name
Relationship :
*
Please Select
Brother
Sister
Aunt
Uncle
Cousin
Other
Relative Residential Address :
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relative cell phone number :
*
EMPLOYMENT DETAILS :
Employer Name (Applicant company name) :
*
Employer Address (company address) :
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company contact number : (preferably landline)
*
Occupation :
*
Number of years at company :
*
Salary Frequency :
*
Please Select
Weekly
Monthly
Fortnightly
Salary date paid ( if monthly ) :
*
Gross income :
*
Nett income :
*
Banking details :
Bank Name :
*
Bank Account Number :
*
Account type :
*
Please Select
Savings
Cheques
SAVINGS OR CHEQUES Acc.
Monthly Expenses :
Rent / Bond :
Water and Lights :
Vehicle Installments :
Personal Loans :
Credit Cards :
Furniture Accounts :
Clothing Accounts :
Policy and Insurance :
Telephone or Cellphone contracts :
Transportation Cost :
Food and Entertainment :
Education :
Maintenance :
Existing vehicles to be settled? If yes specify amount settlement
Do you have a deposit ?
*
Yes
No
Please state the amount of you're deposit : ( if stated yes above)
Please read and understand the T's & C's stated below and tick the box.
*
I hereby consent to the Credit Provider accessing my credit profile from the credit bureaus for the purposes of a credit assessment and in the event that my loan application is successful, for ongoing account maintenance purposes, setting limits, development of credit tools/products/model and insurance purposes and where unsuccessful to Lucid for credit rehabilitation assistance.
Submit
Should be Empty: