Consultants : PAUL : 072 325 5790

iDebtAssist
Purpose of application: Amount

Contact our Specialist Consultant on: Tel: 072 325 5790 Fax: 086 694 7553
Monthly Expenses

New Loan

Advance on existing loan

R

Type / Service

Amount

Personal details (Applicant): Surname Name ID No Tel (W) Fax No Cell
Dependants Physical address Postal address Marital status (√) Ethnic

Personal details (Co-Applicant): Surname Name ID No Tel (W) Fax No. Cell Period at current address Yrs
Postal code

Bond / rental Lease Agree
Credit card Insurance Fuel / Travel Education Loan Payments Mnths Electricity / Water Groceries Clothing Medical Accounts Telephone Domestic Wages Alimony TV / M-Net / DSTV Entertainment

Single

Married ANC Employer Occupation
Employer Address Employment period

COP

Divorced

Employment / Salary Details (Applicant)

Employment / Salary Details (Co-Applicant/Surety)

Employer
Occupation Employer Address Employment period

Basic Salary Average Overtime
Other source of income

R R R

Basic Salary
Average Overtime Other source of income

R R R

Donations Other (Specify) 1. 2. 3. 4. Account number

Highest qualification Income Tax nr:
List of Existing Accounts (Applicant)

Highest qualification Income Tax nr:
List of Existing Accounts (Co-applicant/Surety) Account number

Institution

Type Bond Cheque
Credit Card

Institution

Type Bond Cheque
Credit Card

Total expenses ! Kindly supply the following!

R R R R R R R R R R R R R R R R R R R R R R R

Savings Vehicle Stand No.
Physical Address

Savings Vehicle Security (Fixed property details) Sub / Ext City Code
Purchase Date Bond Acc No Purchase Price

Copy of ID/s of the participants 3 Most recent salary advice 3 Months Bank statements 6 Months Bond statements Title Deed (if applicable) Marriage certificate • If married in C.O.P. forward both parties details & documents • Water and Lights account

Postal Address
Bank Name Market value

R

R

Loan Amount Required

R

Square m² Liabilities Fixed properties (Total)
1. 2.

Mark: Instalment to be paid: Direct Debit ________ Salary Stop Order ________

OWN BUSSINESS (if applicable) • 6 Months Bank Statements • Financial Statements for the last year • Auditor’s letter

Assets Fixed properties (Total)
1. 2.

R R R R R R R R R R R

R R R R R R R R R R R

*Please note that both the applicant’s and the co-applicant / surety’s salary slip, bank and bond statements must be submitted.
I/we declare that the foregoing information is correct. I/we consent to idebtassist making credit enquiries in order to consider this application, and to make available details regarding the management of my / our account/s to credit reference agencies. I we give permission to idebtassist for obtaining information on my / our insurance portfolio in order to assist me / us with my financial planning.

Vehicles (Make/Model)
1. 2.

Vehicles (Make/Model)
1. 2.

Furniture / Household Life Insurance Policies Investments Credit (All Accounts) Other (Specify)

Furniture / Household Outstanding Bonds Bank loans Credit Cards Other (Specify)

______________________________ Applicant Date _______________________________ Co-Applicant Date

Total Assets

Total Liabilities

2

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