Finance Application

Application for Installment Finance
Personal Details
Title * Initials * Surname *
Full Names *
Nationality *
Home Address
Tel (H) *
Tel (W)
Postal Address *
Previous Address *
Spouse Names
Next of Kin
Address
ID No *
Dependants
Date Married
Period
Cell *
Fax
Email *
Code
Period *
Spouse ID
Relationship
Tel
Bond Details
Bond Holder
Property Value R
Purchase Price
Registered
Amount Outstanding
Instalment R /M
Date Purchased
Renting R
Employer Details
Employer *
Industry Type *
Employers Address *
Previous Employer
Salary Date *
Spouse Employer
Tel
Occupation *
Tel *
No of Years
No of Years
No of Years
Occupation
Salary Details
Own Spouse Other
Basic Monthly *(excl Car Allow)
Car Allowance
Total Salary Basic & Car Allow
Monthly Commision
Net Take Home Pay *
Income other than Salary
Sources of other income
Bank Details
Bank Name *
Branch *
Name of Account Holder *
Account Type *
Branch Code *
Account number *
Settle Existing Account *
Account No. to settle
Household Income
Bond Payment / Rent
Vehicle Installments
Credit Card Repayments
Clothing Accounts
Policy / Insurance Payments
Transport Costs
Education Costs
Household Expenses
Household Surplus / Disposable income *
Are You Currently Liable As: *
If you have signed Surety or Co-Debtor Please Indicate the Full Amount Outstanding *
Total Monthly Household Expenses *
Specify Details *
Rates, Water & Electricity
Personal Loan Repayments
Furniture Accounts
Overdraft Repayments
Telephone Repayments
Food & Entertainment
Maintenance
Other
Vehicle Details
Make
Model
Variant
Year
Price
Mileage

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 and obtain an insurance quote.

I hereby declare that all of the above information is true and correct.

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