Mercedes-Benz Sandton Finance Application

Disclaimer*

F&I Management Solutions (PTY) LtdLicensed Financial Services Provider No. 41047(Registration No.2008/004511/07) Section 13 Mandate and Letter of AuthorityContact details: 1 Van Buuren RoadCorner Geldenhuis Road and Van Dort StreetBedfordview2008Tel: 011 607 7517. Complaints and Compliance Department: Email:compliance@faims.co.zaContact. Representative details: Mandated Representative Name: Mafanatu Livie Maluleke. Contact details: 011 263 6500. Financial products which they are accredited to sell:Type of representative: Not ApplicableFinancial products which they are accredited to sell: Type of representative: Not ApplicableAccreditation detailsShort-term insurance (Personal and Commercial lines)National Credit Act Status:He / she is a recognised credit agent and is authorised to completeapplications for credit and advise on matters relating to credit agreementsCompliance management. Compliance arrangements: F&I Management Solutions (PTY) Ltd:•compliance with the Financial Advisory and Intermediary Services Act 37 of2002 (FAIS) is monitored by the Compliance Department.•has the relevant Professional Indemnity Insurance in place.•Representatives earn commission and may be targeted on the products thatthey offer, which must be considered when you make any product decisions.•accepts responsibility for the actions of the Representative mentioned in thisdocument however F&I Management Solutions (PTY) Ltd will not be heldliable in terms of prejudice in respect of services or advice provided by aRepresentative which falls outside the scope of authorisation.Complies with its Conflict-of-Interest Management Policy which is availablefrom the Representative and includes identified potential conflicts of interestand the mitigating controls that have been put in place.is an Accountable Institution and must comply with its obligations in terms ofthe FIC Act, and in order to do so it has to obtain, use, and further processcertain personal and special personal information. If you refuse to providesuch personal information for the purposes of complying with the FIC Actdue to data privacy concerns, please be aware that the FinancialIntelligence Centre has instructed that Accountable Institutions:◦May not establish a business relationship or conduct a singletransaction with a client,◦May not conclude a transaction in the course of a businessrelationship, or perform any act to give effect to a single transaction,and◦Must terminate an existing business relationship with a client••Handling of complaints:In the unlikely event that your are dissatisfied with any aspect of ourservice, you should address your complaint in writing to F&IManagement Solutions Compliance Department at the above address.Should your complaint not be adequately resolved, you may take thematter to the FAIS Ombud:Office of the FAIS Ombud P.O. Box 74571 Lynwood Ridge 0040I hereby CONFIRM that I have received a copy of this document with the above mentioned information as required by lawI hereby UNDERSTAND that you will process my personal information only where you have a lawful justification to do so and, incircumstances where it is required by law, you will obtain my consent prior to processing my personal informationI hereby APPOINT the representative as my agent for the purpose of arranging my vehicle finance and other products relatedto the purchase of the vehicleI CONSENT to F&I Management Solutions (Pty) Ltd (F&I), a licenced Financial Services Provider, processing my personalinformation in order keep me up to date with general information regarding the products or services arising from this transaction.I UNDERSTAND that I may opt-out of the communication addressed to me by F&I by clicking the “unsubscribe” button in thecommunications.I FURTHER CONSENT to F&I providing this information to members of Motus Mobility Solutions (LiquidCapital, MSure,MotorHappy, SA Vehicle Maintenance) for the purpose of marketing products and services provided by members of the group thatcannot be or have not been provided by F&I.I FURTHER UNDERSTAND that I may opt out of any communications addressed to me by other members of the Motus MobilitySolutions by clicking the “unsubscribe” button in any of the communications. This form is 100% safe, it has been designed by Mercedes-Benz Sandton. The form will request personal information such as ID Number, Contact Details, and Address. Please note banking details are not compulsory (Mercedes-Benz Sandton will contact you personally for that information). Should you feel uncomfortable with giving this information please contact Mercedes-Benz Sandton or your Sales Executive on +27 11 263 6500. Please accept this disclaimer to continue, Thank You.

Vehicle of Interest*

Sales Person*

Name*

First NameLast Name

ID Number*

Contact Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry

How long have you been staying there?

Property Details*

Graduated*

Marital Status*

Spouse Name

First NameLast Name

Date Married

Date

Marriage type*

Next of Kin*

First NameLast Name

Relationship to You*

Contact Number*

Please enter a valid phone number.

Next of Kin Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Bank Name

Account Number

Account Holder

Company Name*

Position*

Company Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry

Company Number*

Please enter a valid phone number.

How long have you been there?*

Salary Date*

Salary before Deductions*

Salary after Deductions*

Other Income

Source of Other Income

Bond / Rent

Vehicle (if not settling)

Rates / Water / Electricity

Personal Loans

Credit Cards

Clothing Accounts

Cell Phone / Internet

Food & Entertainment

Disclaimer*

I hereby grant the F&I Manager of Mercedes-Benz Sandton to submit my application for the above vehicle and all related value added products on my behalf.

ID Copy*

Drivers License

3 Payslips

Proof of Address

3 Months Bank Statement

Signature*

Personal Information

Banking Details

Employment Information

Income & Expenses