Application for Vehicle Finance
Please complete the Application form.
I hereby confirm the Following:
*
I am not under Debt Review
I earn more than R6500.00
I have a valid drivers license
Full Names & Surname
*
First Name
Last Name
ID Number
*
Gender
Please Select
Male
Female
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Marital Status
Please Select
Single
Married
Divorced
Widow/er
Email Address
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you Bonded, Bond Free or Tenant? Please choose
Please Select
Bonded
Bond Free
Tenant
Period at current Home Address (years)
Employer Name
*
Occupation
*
Employment type
Please Select
Individual
Self Employed
Pensioner
Industry Type
Please Select
Business Services
Commerce
Construction
Government
Manufacturing
Medical
Mine
Retail
Transport
If Self employed, please state your company name
Is your company Registered?
Yes
No
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Period at Employer
Gross Income
*
Nett Income
*
Income other than salary ( Must be able to be proven with Bank statements)
*
Specify Other Income
Please Select
Consulting
Pension
Rent
Sales
Transport
Rent/ Bond Payment
Vehicle Installment (If not settling)
Personal Loan
Credit Card
Furniture Account
Clothing Account
Policy/ Insurance
Telephone
Transport Cost
Food & Entertainment
Houshold
Next of Kin - PLEASE NOTE: NOT RESIDING AT THE SAME ADDRESS AS APPLICANT
*
First Name
Last Name
Next of Kind Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Next of Kin Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Bank Name
Bank Account Number
Account Type
Please Select
Savings
Cheque
Current
Do you have a trade in?
Yes
No
Is the Vehicle still under Finance?
Yes
No
Do you have a Deposit?
Yes
No
Salary Payment Date
First installment date
-
Month
-
Day
Year
Date
I hereby confirm that the above information is true and correct.
Yes
We require your consent to utilise this information for the application for vehicle finance and products that will be made available to you. I hereby consent to the information to be made available to credit providers. I hereby consent you to collect data from the credit providers/ bureaus to verify my information given by me on the application form.
Yes
Signature
E M Kock
0710065710
Submit
Should be Empty: