FINANCING Finance Application CONDITION Used MODEL MAKE M&M CODE FULL VEHICLE DESCRIPTION DEPOSIT PRICE (VAT INCL) TRADE-IN YesNo PRICE OFFERED FINANCE HOUSE ACCOUNT NUMBER MONTHLY INSTALLMENT DEALERSHIP NAME SALES PERSON CONTACT NUMBER DEALER EMAIL COPY OF ID 3 MONTHS PAYSLIP PROOF OF RESIDENCE 3 MONTHS BANK STATEMENTS TITLE SURNAME ID NUMBER FULL NAMES INITIALS DEPENDENTS GENDER MALEFEMALE MARITAL STATUS SINGLEMARRIEDWIDOWEDDIVORCED DATE MARRIED HOME ADDRESS HOW LONG HAVE YOU LIVED THERE? YOUR CELL NUMBER YOUR EMAIL TEL (H) TEL (W) POSTAL ADDRESS CODE FIRST NAME SURNAME ID NUMBER CELL FIRST NAME SURNAME CELL PHYSICAL ADDRESS RELATIONSHIP TYPE BANK NAME OUTSTANDING AMOUNT MONTHLY INSTALLMENT REGISTERED IN OwnSpouseBoth EMPLOYER NAME: OCCUPATION/TRADE: EMPLOYER ADDRESS: CONTACT NUMBER: PERIOD IN YEARS: PERIOD IN MONTHS: SPOUSE EMPLOYER: OCCUPATION/TRADE: EMPLOYER ADDRESS: CONTACT NUMBER: PERIOD IN YEARS: PERIOD IN MONTHS: BANK NAME: BRANCH NAME: BRANCH CODE: ACCOUNT TYPE SAVINGSCHEQUE NAME OF ACCOUNT HOLDER: ACCOUNT NUMBER: YOUR BASIC SALARY MONTHLY (EXCL. CAR ALLOWANCE): SPOUSE BASIC SALARY MONTHLY: (R) YOUR CAR ALLOWANCE: SPOUSE CAR ALLOWANCE: (R) YOUR TOTAL SALARY (CAR ALLOWANCE & BASIC): (R) SPOUSE TOTAL SALARY (CAR ALLOWANCE & BASIC): (R) YOUR MONTHLY COMMISSION: (R) SPOUSE MONTHLY COMMISSION: (R) YOUR NET TAKE HOME PAY: (R) SPOUSE NET TAKE HOME PAY: (R) YOUR OTHER INCOME: (R) SPOUSE OTHER INCOME: (R) YOUR SOURCE OF OTHER INCOME: (R) SPOUSE SOURCE OF OTHER INCOME: (R) TOTAL HOUSEHOLD INCOME (APPLICANT & SPOUSE): (R) BOND REPAYMENT/RENT: (R) VEHICLE INSTALMENT (EXCL TRADE IN/ THOSE TO BE SETTLED): (R) RATES/WATER & ELECTRICITY: (R) PERSONAL LOAN REPAYMENTS: (R) CREDIT CARD REPAYMENTS: (R) FURNITURE ACCOUNTS: (R) CLOTHING ACCOUNTS: (R) OVERDRAFT REPAYMENTS: (R) POLICY/INSURANCE REPAYMENTS: (R) TELEPHONE REPAYMENTS: (R) TRANSPORT COST: (R) FOOD & ENTERTAINMENT: (R) EDUCATION COST: (R) MAINTENANCE: (R) HOUSEHOLD EXPENSES: (R) OTHER: (R) TOTAL MONTHLY HOUSEHOLD EXPENSES: R HOUSEHOLD SURPLUS/ DISPOSABLE INCOME: R * I confirm that: A) I am not a minor. B) I have not been declared mentally unfit by a South African court. C) I am not subject to administration order. D) I do not not have any current application for debt restructuring or alleviation. E) I do not have any debt rearrangement in place. F) I have not previously applied for debt rearrangement. G) I am not under sequestration. H) I do not have any pending applications for credit nor open quotations as envisaged in section 92 of the National Credit Act 2005. I) If any of the above is incorrect, state which and give details. SUBMIT APPLICATION