Application for instalment finance

CHOOSE AN OPTION
Personal LoanVehicle Finance

GOODS DESCRIPTION
NewUsed Model: Make: M&M Code:

THE CAR FINANCE
Contact Person: Sales Person:
Tel: Fax:
Cash Price(Vat Incl): R
Extras: R

Licence/Reg: R
Extras: R
Extras: R

Warranty: R
Approx Instalment: R
S&D: R:
Deposit: R

PERSONAL DETAILS
Title: Surname: Initials: Full Names:
MaleFemale ID No: Dependants:
Married ANCCOP
Date Married Single:Widowed:
Home Address: Period: Y M
Postal Address: Code:
Tel(H): Tel(W): Cell:Spouse Names: Spouse ID No: Next of Kin: Relationship: Tel: Address:

BOND DETAILS
Bank: Outstanding Amount: Instalment:
Registered in:Own NameSpouse NameBoth

EMPLOYER DETAILS
Employer: Occupation: Period: Y M
Employer Address: Employer Tel:
Spouse Employer: Occupation:
Employer Tel:
Period: Y M

BANK DETAILS
Bank Name: Type Of Account:ChequeTransmissionSavings Branch Code:
Name of Account Holder: Account No:

SALARY DETAILS
OWN Basic Monthly (Excl Car Allowance) :
SPOUSE Basic Monthly (Excl Car Allowance) :

OWN Car Allowance :
SPOUSE Car Allowance :

OWN Total Salary (Basic & Car Allowance) :
SPOUSE Total Salary (Basic & Car Allowance) :

OWN Monthly Commission :
SPOUSE Monthly Commission :

OWN Net Take Home Pay :
SPOUSE Net Take Home Pay :

OWN Income Other than Salary/Wages :
SPOUSE Income Other than Salary/Wages :

OWN Total Monthly Household (Net + Other) R :

MONTHLY HOUSEHOLD EXPENSES
Bond Payment / Rent R:
Vehicle Instalments(Excluding those that need to be settled) R:
Credit Card Repayments R:
Clothing Accounts R:
Policy / Insurance Repayments R:
Transport Costs R:
Educations Costs R:
Household Expenses R:
Rates, Water & Electricity R:
Personal Loan Repayments R:
Furniture Accounts R:
Overdraft Repayments R:
Telephone Payment R:
Food and Entertainment R:
Maintenance R:
Other R:

Total Monthly Household Expenses R:
Household Surplus / Disposable Income R:

I hereby give consent to the Credit Provider to make enquiries about my credit record with any of the credit agencies and to obtain whatever information on me that they might require to process the credit application and / or application for insurance. I hereby declare that all of the above information is true and correct.

Signature:
Date :