INDIVIDUAL APPLICATION FORM
KIA N1 CITY - DON
Personal Details
Name
*
First Name
Last Name
ID Number
*
Gender
Male
Female
Status
*
Single
Married
Seperated
Divorced
Widowed
Highest Qualification
*
Married COP / ANC & DATE OF MARRIAGE
TELEPHONE NUMBERS
Personal Cell number
*
Format: (000) 000-0000.
Personal Email
*
example@gmail.com
Employer Phone Number
*
Format: (000) 000-0000.
RESIDENTIAL ADDRESS
Current Address
*
Street Address
City
Province
Area Code
Period living at address
Residential address ownership
*
Living with Family
Renting
Homeowner
Occupation Details
Employment Category
*
Employed
Self Employed
Pensioner
Type of Industry
*
Employer Name
*
Occupation
*
Employer Address
*
Salary Date
*
Period at Company
Income
Monthly Gross Income (Before Deductions)
*
in Rand
Monthly Net Income (After Deductions)
*
in Rand
Monthly Expense
BOND / RENT
RATES / WATER / ELECTRICITY
PERSONAL LOANS
CREDIT CARD
FUEL COST
TELEPHONE / INTERNET
FOOD / ENTERTAINMENT
EDUCATION
FURNITURE ACCOUNTS
CLOTHING ACCOUNTS
POLICY PAYMENTS
INSURANCE COSTS
OVERDRAFT
MAINTENANCE
VEHICLE REPAYMENT (NOT TRADING IN)
SECURITY EXPENSES
OTHER COSTS
Spouse Details (If Married)
NAME
SURNAME
ID Number
Cellphone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Next of Kin Details (Relative / Friend NOT LIVING WITH YOU)
Name
*
Surname
*
Relationship with Person
*
Residential Address
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Banking Details
Bank Name
*
Account Number
*
Account Type
*
Current
Saving
Preffered monthly debit date
*
Vehicle Interested in.
New or Used
Make & Model
Trade-in Details (If applicable)
Year Model
Vehicle Description
Mileage
Do you owe the bank? If so, which Bank.
Finance (Needs Analysis)
Payment
*
Cash
Finance
Preffered Monthly Installment
*
Terms
*
72 Months
84 Months
96 Months
Step Payment
Do you require a balloon?
*
YES
NO
Do you have a deposit? (Cash)
*
YES
NO
Do you require a quote for short term insurance cover for the vehicle being damaged or loss?
*
YES
NO
Do you require shortfall insurance to ensure that your obligations under Credit agreement can be met in the event that there is a difference between the amount paid by insurer and the amount owed to the Credit Provider at the time of the vehicle loss?
*
YES
NO
Do you require cover to refund your deposit (Maximum 10% of vehicle selling price) in the event of the car being written of or stolen?
*
YES
NO
Do you require cover in the event of mechanical failure on the vehicle? (new or extension to the factory product)
*
YES
NO
Would you like to provide upfront for future vehicle servicing costs? (New or extension to the factory product)
*
YES
NO
Would you like to provide for unforseen cost of certain wear & tear items on the vehicle? (new or extension to factory product)
*
YES
NO
Do you require scratch and dent?
*
YES
NO
I confirm that:
I am not a minor.
I have never been declared mentally unfit by a court.
I am not subject to an Administration Order.
I do not have any current application pending for dept restructuring or alleviation.
I do not have any current dept re-arrangement in existence.
I have not previously applied for a dept re-arrangement.
I am not under sequestration.
I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.
I hereby give consent to the Credit Provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the application. I also give consent to the credit provider to share my payment behaviour with any credit agency.
I hereby give consent to the Credit provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the credit application and / application for insurance.
I understand that I will be liable for a monthly service fee.
I consent to this Credit Provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider’s obligation under the National Credit Act.
I hereby declare that the information provided by me is true and correct.
Signature
*
Submit
Should be Empty: