VEHICLE FINANCE APPLICATION FORM
Please complete the Application Form
I hereby confirm the following:
*
I am not under Debt Review
I earn more than R 9 000.00 Nett
I am blacklisted
I am applying for Bank Financing
I am applying for Rent To Own Financing
Do you have a valid driver's licence?
*
Please Select
Yes
No
Name
*
First Name
Last Name
ID Number
*
Gender
*
Please Select
Male
Female
Other
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
Marital Date
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Full Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you Bonded, Bond free or Renting?
*
Please Select
Bonded
Bond Free
Renting
Number of years at current Home Address
*
Occupation
*
Name of Company you work for
*
Employment Type
*
Please Select
Individual
Self Employed
Pensioner
Industry Type
*
Please Select
Business Services
Commerce
Construction
Government
Manufacturing
Medical
Mining
Retail
Transport
Other
If Self Employed, please state your company's name
Is your company registered?
Yes
No
Full Address of Employer
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of years at current employer
*
Gross Income
*
Nett Income
*
Salary Paid
*
Please Select
Monthly
Weekly
Fortnightly
Day of the month salary gets paid
*
Other income in Rands
Specify other income
Please Select
Consluting
Pension
Rent
Sales
Transport
Other
Monthly Expenses
Monthly Rent/Bond Payment - Enter 0 if not paying anything
*
Monthly Personal Loan Payment
Monthly Credit Card Payment
Monthly Furniture Account Payment
Monthly Clothing Account Payment
Monthly Policy/Insurance Payment
Monthly Telephone/Mobile Phone Payment
Monthly Transport Costs
Monthly Food & Entertainment Costs
Monthly School Fees
Next of Kin - PLEASE NOTE: A PERSON NOT RESIDING AT THE SAME ADDRESS AS APPLICANT
*
First Name
Last Name
Next of Kin - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relation to Next of Kin
*
Next of Kin - Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Bank Name
*
Bank Account Number
*
Bank Account Type
*
Please Select
Savings
Cheque
Current
Do you have a trade-in?
*
Yes
No
Is the trade-in vehicle still under Financing?
*
Please Select
Yes
No
Not Applicable
Do you have a Deposit?
*
Yes
No
How much deposit - Enter 0 if no deposit
*
Monthly Installmet you can Afford
*
Choice of Vehicle Required
Option 1:
*
ex: VW Polo
Option 2:
ex: Ford Fiesta
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 being made available to credit providers. I also give my permission, for data to be collected from credit providers/bureaus, to verify the information given by me, on the application form.
*
Yes
Submit
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