Application Form
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Are you currently under debt review?
*
Yes
No
Do you have a drivers license?
*
Yes
No
Description of the vehicle you are applying for:
*
Installment type
*
With deposit
No deposit
Deposit amount
Full Names
*
First Name
Last Name
Full names
*
Surname
*
ID Number
*
Date of Birth
*
Gender
*
Male
Female
Other
Ethnic Group
*
African
Coloured
Indian
White
Asian
Other
Country Nationality
*
Marital Status
*
Single
Married
Divorced
Widower
Marital Type
COP
OCOP
Customary/Tribal law
Married under foreign law
Date Married
-
Day
-
Month
Year
Date
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternative Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bond Owner
Owner- Bonded
Owner - Bond free
Tenant
Lodger
Living with parents
Other
Period living at this address
Employer Details
Employer Name
*
Employer Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
*
Industry Type
Private sector
Government sector
Farming
Mining
Self-employed
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Period Employed (years)
*
Gross Salary (before deductions)
*
Net Salary (after deductions)
*
Salary Date:
*
Frequency of Salary
*
Monthly
Weekly
Fortnightly
Other
Monthly Expenses
Please indicate your monthly expenses
Bond Payment
Monthly Rent
Water & Electricity
Car Bond Payment
Personal Loan
Credit Card
Furniture Accounts
Clothing Accounts
Policy / Insurance
Telephone Payments
Transport Cost
Food & Entertainment
Education Cost
Household Expenses
Relative Details
(With Different address - not living with you)
Full Name and Surname
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Banking Details
Bank Account Holder Name
*
Bank Name
*
Account Number
*
Account Type
*
Savings
Cheque
Transmission
Other
Informed Consent
This form complies with the requirements of the Protection of Personal Information Act (Act 4 of 2013) (POPIA).
I do Consent
I hereby consent to Auto Alive accessing my credit profile from the credit bureaus for the purposes of a credit assessment and possibly a finance application for the purpose of purchasing a vehicle. I hereby consent that my application for credit, together with my personal information be submitted to all major vehicles finance banks and carefully selected business partners for the purpose of vehicle finance and insurance.
I do not consent
If you do not wish us to disclose this information to us or any other parties, please contact us at the contact details set out herein. We may,however, not be able to provide products or services to you if such disclosure is necessary.
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