Vehicle Finance Application Form

Applicant Personal Details

All fields marked with * are required

Name:*

Surname:*

ID Number:*
Cell Number:*
Email:*
Marital Status:*
If Married, Date of Marriage:

Applicant Address

Street Address:*	Suburb:*
City:*	Province:
Postal Code:	Country:

Next of Kin Details

All fields marked with * are required

Full Names:*
Cell Number:*

Next of Kin Address

Street Address:*	Suburb:*
City:*	Province:
Postal Code:	Country:

Relationship:*

Banking Details

All fields marked with * are required | Account number is not required, however it helps speed up the application process.

Bank Name:*
Account Holder:*
Account Number:
Type Of Account:*

Income & Expenses

All fields marked with * are required

Income

Gross Salary:*

Nett Salary:*

Car Allowance:

Commission:

Other Income:

State Other Income:

Expenses

Rent/Bond:*

Vehicle Installments:

Credit Card:

Insurance Policy:

Loans:

Food & Entertainment:*

Employer Details

All fields marked with * are required

Name Of Company:*
Employer Contact Person:*
Contact Number:*
Employer Email:*

Applicant Address

Street Address:*
Suburb:*
City:*
Postal Code:
Province:
Country:
Date of Employment:*
Occupation:*

Applicant Consent & Declaration

*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 credit application and to share my payment behaviour with any credit agency.

I confirm that:*

✔ I am not a minor.

✔ I have never been declared mentally unfit by a South African court.

✔I am not subject to an administration order.

✔ I do not have any current application pending for debt restructuring or alleviation.

✔ I do not have any current debt rearrangement in place.

✔ I have not previously applied for debt rearrangement.

✔ I am not under sequestration.

✔ I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act, 2005.

✔ If any of the above is incorrect, state which and give details.

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

Applicant Address

Next of Kin Address

Income

Expenses

Applicant Address

Car Finance

Rent To Own