WE ASSIST WITH VEHICLE FINANCING
Referred by
Are you currently under (DEBT REVIEW) ?
Please Select
YES
NO
Do you have a valid driver's license?
*
Please Select
Yes
No
Vehicle your looking for ?
*
What is your monthly installment budget?
Title:
*
Please Select
Mr
Mrs
Miss
Applicant Name
*
First Name
Middle Name
Last Name
I'D Number
*
South African I'D Number
I'D Number Confirm
*
South African I'D Number
Applicant Email
Applicants Cell number
*
Alternative Cell Number
Home Address
*
Street Address
Street Address Line 2
City
Province
Zip Code
Years at address
*
Months at address
*
Marital status:
Please Select
Single
Anc
In community
Traditional
Marriage date:
SPOUSES NAME AND SURNAME
First Name
Last Name
Spouses Cell Number:
Address
Street Address
Street Address Line 2
City
Province
Postal / Zip Code
NEXT OF KIN (RELATIVE) NAME AND SURNAME
*
First Name
Middle Name
Last Name
Next of Kin (Relative) Cell number
*
Relationship:
*
Next of kin (Relative) address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name (as on payslips)
*
Occupation
*
Work Number (landline)
*
Format: (000) 000-0000.
Frequency of salary:
*
Please Select
Monthly
Weekly
Every second week
Company's Address
*
Street Address
Street Address Line 2
City
Province
Zip Code
How Many Years employed
*
How Many Months employed
*
Salary date
*
Gross Income (Before Deduction's)
*
Nett Income (payed into your account)
*
Bank account number
*
Bank name
*
Cheque or Savings
*
Rent/bond
Water and lights
Vehicle installments
Personal loan
Credit card
Furniture accounts
Clothing accounts
Policy's and insurance
Telephone payments
Food and entertainment
Transport costs
Education
Maintenance
Existing vehicles to be settled?if yes specify amount settlement
IF YOU HAVE A DEPOSIT PLEASE PUT THE AMOUNT BELOW
*
*
I hereby consent to the Credit Provider accessing my credit profile from the credit bereaus 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: