Application for Vehicle Finance
Please complete the Application form.
I hereby confirm the Following:
*
I am not under Debt Review
I am under debt review
I earn more than R8000.00
I have a valid drivers license
Full Names & Surname
*
First Name
Last Name
ID Number
*
Gender
*
Please Select
Male
Female
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Marital Status
*
Please Select
Single
Married
Divorced
Widow/er
How are you married
ANC(Out Community of property)
COP(In community of property)
Traditional/Tribal
Date Married
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you Bonded, Bond Free or Tenant? Please choose
*
Please Select
Bonded
Bond Free
Tenant
Period at current Home Address
*
Employer Name
*
Occupation
*
Employment type
*
Please Select
Individual
Self Employed
Pensioner
Industry Type
*
Please Select
Business Services
Commerce
Construction
Government
Manufacturing
Medical
Mine
Retail
Transport
If Self employed, please state your company name
Is your company Registered?
Yes
No
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Period at Employer
*
Gross Income
*
Nett Income
*
Other Income
*
Specify Other Income
Please Select
Consulting
Pension
Rent
Sales
Transport
Rent/ Bond Payment
Vehicle Installment (If not settling)
Personal Loan
Credit Card
Furniture Account
Clothing Account
Policy/ Insurance
Telephone
Transport Cost
Food & Entertainment
Houshold
Next of Kin - PLEASE NOTE: NOT RESIDING AT THE SAME ADDRESS AS APPLICANT
*
First Name
Last Name
Relationship of next of kin:
*
Next of Kind Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Next of Kin Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Bank Name
*
Bank Account Number
*
Account Type
*
Please Select
Savings
Cheque
Current
Do you have a trade in?
Yes
No
Is the Vehicle still under Finance?
Yes
No
Do you have a Deposit?
Yes
No
Salary Payment Date
*
1st Instalment Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Vehicle interested in
I hereby confirm that the above information is true and correct.
Yes
We require your consent to utilise this information for the application for vehicle finance and products that will be made available to you. I hereby consent to the information to be made available to credit providers. I hereby consent you to collect data from the credit providers/ bureaus to verify my information given by me on the application form.
Yes
Submit
Should be Empty: