Application Form Optima

IMPORTANT: Please note that your Application is not complete until you have sent in or brought in your relevant documentation.

Please see displayed message after you have filled in this form for further instructions.
Contact Information

Applicant
Name*

PrefixFirst NameLast Name
Title:
Birth Date*

DayMonthYear
Do you have a :*

SA IDForeign Passport
Foreign Passport #*
Please enter Passport number
ID Number # ( OR) Passport #*
Foreign Passport ( country held in )
Country
E-mail*
example@example.com
If you are not a SA citizen
Please enter Passport number
Address*

Street Address

Street Address Line 2

SuburbGauteng

Postal / Zip Code
Phone*
How long have you lived in your given(above) address?

0-1 Year1-2 Years3 years +
What unit price suits your rental budget?*
Is the Applicant the same person responsible for rent?*
Title:
Person responsible for rent
Name*

First NameLast Name
Birth Date

MonthDayYear
Passport country held in
Country
E-mail*
example@example.com
ID Number #
Address

Street Address

Street Address Line 2

SuburbGauteng

Postal / Zip Code
Employment Information

Person responsible for rent
Are you self employed *
If self employed , please provide :
- ck or company documents
- letter from accountant confirming net income
Present Employer ( Company name)*
Work telephone number*
Years of employment*

1-2 Years3 Years +
Net monthly income*
Amount as seen on bank statements
Address / Area of Business*
Current position*
I hereby agree that the Credit Grantor may via one or more credit berueas: preform credit search on my credit profile; monitor my payment profile ; use any new information or data on any future credit applications; record whether the account is being conducted satisfactory*

Agree and give consent
Upload ID or Passport here

Cant Upload NO PROBLEM just hand deliver them
Cancelof
Upload Payslip here

Cant upload NO PROBLEM just hand deliver
Cancelof
Upload Bank Statements here

Cant upload NO PROBLEM just hand deliver them
Cancelof
Signature ( sign/ draw with finger in box below) *

Clear
I agree to receive email or sms communication from Live Easy for marketing purposes (events, statements and other special offers).
Should be Empty:

Contact Information

Employment Information