APPLICATION FORM
S.A Drivers Licence :
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Yes
No
TITLE, FULL NAME & SURNAME :
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Mr.
Mrs.
Miss
Doctor
Advocate
Professor
Reverend
Title
First Name
Last Name
Race/ Ethnic Group :
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Black
White
Asian
Coloured
Indian
S.A ID No :
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Confirm S.A ID No :
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Marital Status (It very is important to state) :
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Please Select
Single
Married
Widowed
Divorced
Marital Contract (IMPORTANT) :
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Please Select
In Community Of Property
Antenuptial Contract (Out Of Community)
Tribal
Single
Other
Date Married :
E-mail :
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Cell Phone number :
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WhatsApp number :
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Applicant Residential Address (PLEASE STATE FULL ADDRESS AND POSTAL CODE) :
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years at this address :
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EMPLOYMENT DETAILS :
Employer Company Name (WHAT COMPANY YOU WORK FOR) :
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Occupation :
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Employment type :
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Self Employed
Temporary Employed
Permanently Employed
Contract Worker
Employment Level :
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Please Select
Senior Management
Management
Supervisor
Skilled Worker
Semi-Skilled Worker
Unskilled Worker
Junior Position
Employer Address (company address) :
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company contact number : (preferably landline)
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Period Employed :
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Salary Frequency :
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Please Select
Weekly
Monthly
Fortnightly
Gross income :
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Nett income :
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Other income :
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Applicant Bank Name :
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Household :
Owner/Tenant :
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Bond
Rent
Living with parents
Bond / Rent Amount :
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Relative Information :
Next of kin details :
Relative FULL NAME & SURNAME :
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First Name
Last Name
Relationship :
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Please Select
Father
Mother
Brother
Sister
Aunt
Uncle
Cousin
Father In Law
Mother In Law
Wife
Other
Relative cell phone number :
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Relative Residential Address :
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Street Address
Street Address Line 2
City / Province
Postal Code
Postal / Zip Code
Please read and understand the T's & C's stated below and sign :
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Yes, I authorize Gemin Motors to share my data with contractually bound credit providers and their partner lenders to retrieve my credit report to assess my creditworthiness before making a final lending decision on my loan application. I authorize Gemin Motors to contact, request and obtain credit information from a registered credit bureau to verify my identity, perform an assessment of my behavior, profile, payment patterns, indebtedness and creditworthiness, or for other related purposes in any format available from a registered credit bureau.
Signature
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Submit
Should be Empty: