We need:
  • Valid Drivers Licence copy
  • RSA Barcoded ID copy
  • Proof of physical address – water/lights account (Not older than 3 months)
  • Completed e-application
  • Latest proof of income e.g. payslip
Personal Details:
Title
Surname
ID No:
Full Names
Initials
Dependants
Male
Female
Married
ANC
COP
Single
Widowed
Date Married
Tel: (H)
Tel: (W)
Cell:
Fax
E-Mail
Home Address
Period
Postal Address
Code
Previous Address
Period
Spouse Names
Spouse ID
Next of Kin
Relationship
Address
Tel
Bond Details:
Bond Holder Outstanding
R
Date Purchased
Registered: Own Name Spouse
Renting
R
Employer Status:
Employer
Occupation
Employer Addres
Tel:
No.of Years
Salary Date
Previous Employer
No.of Years
Spouse Employer
No.of Years
Tel:
Occupation
Bank Details:
Bank Name
Branch Name:
Branch Code
Name of Account Holder
Account No.
Credit Card
Savings
Transmission
Current
Trade Reference:
Branch
Account No.
Installments
Paid up / Current / To be Settled
Ethnic Group:  
African
Coloured
Indian
White
Language Preference
English
Afrikaans
Zulu
Sotho
Other
Personal Application:  
    Own
  
    Spouse
Salary Details
R
R
Basic Monthly (Excl.car Allowance)
R
R
Car Allowance
R
R
Total Salary (Basic & Car Allowance)
R
R
Monthly Commission
R
R
Net Take Home Pay
R
R
Income other than Salary / Wages**
R
R
Sources of other Income**
R
Total Monthly Household Income
(Net Salary & Other
R
Household Expenses per Month
Bond Repayment / Rent
R
 Rates, Water & Electricity
R
Vehicle Installment
(Excluding those to be settled)
R
 Personal Loan Repayments
R
Credit Card Repayments
R
 Furniture Accounts
R
Clothing Accounts
R
 Overdraft Repayments
R
Policy / Insurance repayments
R
 Telephone Repayment
R
Transport costs
R
 Food & Entertainment
R
Education Costs
R
 Maintenance
R
Household Expenses
R
 Other
R
Total Monthly Household Expenses
R
Household Surplus / Disposable Income
R
Are you Currently Liable as:
Surety
Guarantor
Co-Debtor
Specify Details
If you have signed Surity or Co-Debtor, Please indicate the full amount Outstanding
R

I Confirm that:

A. I am not a minor.
B. I have never been declared mentally unfit by a court.
C. I am not subject to an administration order.
D. I do not have any current application pending for debt restructuring or alleviation.
E. I do not have any current debt re-arrangement in existence.
F. I have not previously applied for a debt re-arrangement.
G. I am not under sequestration.
H. I do not have applications pending for credit,
nor open quotations as envisaged in section 92 of the National Credit Act.
I. If any of the above is incorrect, give details:
Declaration by Client:
  Y N
I hereby grant the Credit Provider the right to communicate with me throught any electronic/written media or verbally in order to make available to me, their product offering
I hereby grant the Credit Provider the right to increase my Credit Limit once every year to accommodate ant Value Added Products needed and requested by me.
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 behavior with any credit agency.
 

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