Individual Application

For Finance

Applicant’s Personal Details

Applicant Type Individual Sole Proprietor Surety/Co-Guarantor

Trading as

Income Tax Number

VAT Registration Number

Full Names

Identification Number

Passport Number

Nationality

Date of Birth D D / M M / Y Y Y Y

Language of Choice English Afrikaans

Marital Status Single Married Divorced Separated Widowed Cohabiting

Other:

Marital Regime Married in Community of Property

Married out of Community of Property (with accrual)

Married out of Community of Property (without accrual)

Other:

Number of Dependants
(including your spouse)

Were you previously

Yes No
disadvantaged?
Do you own your own
Yes No
property?

Residential Address

Postal Code

How long did you reside Y Y / M M

at your present address?
How long did you reside Y Y / M M
at previous address?

Home Telephone Number -

Cellphone Number -

Postal Address

Postal Code

Email Address

Address where vehicle

will be kept
Postal Code

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 1
Employer’s Details

Employer’s Name

Occupation

Employer’s Address

Postal Code

Telephone Number -

Email Address

Length of Service Y Y / M M

Length of Service with Y Y / M M

previous employer

Spouse’s Details

Full Names

SA Identification Number/
Passport Number
Employer’s Name

Nationality

Telephone Number -

Details of a family member not living with you:

Full Names

Relationship

Residential Address

Postal Code

Telephone Number -

Cellphone Number -

Vehicle Details

M & M Code

Model Y Y Y Y

Vehicle Description:

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 2
POPIA Checklist

POPIA Declaration Yes No

Are you a minor?

Have you ever been declared mentally unfit by a court?

Are you subject to an Administration Order?

Do you have any current applications pending for debt restructuring/alleviation?

Do you have any current debt re-arrangements?

Have you previously applied for a debt re-arrangements?

Do you have any application pending for credit with any other credit provider?

Are you currently under sequestration?

Do you have any open quotations per Section 92 of the National Credit Act?

Finance Details

Details Description Value

Retail purchase price R

Discount R

Accessories (E.g. Sun-roof, aircon, tow-hitch etc.) R

Value Added Extras R

Do you wish to pay the initiation fee of R1000

Yes No
(excl VAT) in cash?

Value Added Tax calculated at: 15% R

Deposit (cash, trade in) R

Principal Debt R

Balloon Payment (if allowed) % R

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 3
Dealership Details

Dealership Name

Salesperson’s Name
Telephone/Cellphone
-
Number

Loan Details

Instalment Sale Lease Rental Term

Day of the month to be 1st 15th 25th

debited
Document delivery Post/ Fax Email
manner Standard Mail

Marketing

Would you like to receive information on new products and offerings from Bidvest Bank?

Yes No

If you agree, we will communicate with you via the contact details provided in Section A and the method(s) selected below. If any other number or email address
must be used, please specify below:

Email Address

SMS -
(Provide Cellphone Number)

Bank Account Details

Bank Name

Branch

Account Number

Branch Code

Type of Account Current Savings Cheque

Other:

Name of Account holder

Statutory Affordability Assessment (National Credit Act 34/2005)

Income (does not replace current payslip)

Salary (Gross) R

Car Allowance R

Commission R

Fuel Allowance (if any) R

Investment Income R

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 4
 Income (does not replace current payslip)

Pension R

Disability R

Other: R

Income Total R

Fixed Expenses

Life Insurance R

Home Insurance R

PAYE R

Pension R

Medical Aid R

UIF R

Rent R

Levy R

Other: R

Fixed Expenses Total R

Household Expenses

Utilities R

Fuel R

Household Maintenance R

Vehicle Maintenance R

Transportation R

Creche/School/College/University Fees R

Wages R

Telephone R

Cellphone R

Medical R

Licence Fees R

Entertainment/Mnet/DSTv R

Food & Groceries R

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 5
 Household Expenses

Subscription R

Donations R

Other: R

Household Expenses Total R

Debts (Description) Limit Balance Instalment

Fixed Term Debt

Mortgage R R R

Vehicle Finance R R R

Personal Loans R R R

Term Loans R R R

Educational Loan R R R

Other: R R R

Revolving Debt

Total Credit Card R R R

Total Budget Card R R R

Total Current Account R R R

Total Retail Loans (clothing, furniture, etc.) R R R

Total Revolving Loan R R R

Total Fixed Term R R R

Total Revolving Debt R R R

Other Costs:

1. Does this vehicle replace an existing one which you own?

Yes No

2. Is this an additional vehicle?

Yes No

If the answer to 1 above is Yes, provide estimates for:

Monthly Petrol Costs R

Annual Licence Renewal R

Annual Vehicle Maintenance Costs R

Annual Vehicle Comprehensive Insurance R

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 6
If the answer to question 2 is Yes, supply the following:

Monthly Instalment on Existing Vehicle R

Monthly Comprehensive Insurance on Existing Vehicle R

Monthly Maintenance Costs on Existing Vehicle R

Consent and Declaration

I/We understand that I/we will be liable for a monthly Service Fee.

I/We hereby consent to the Bank making enquiries about my/our credit record and carrying out fraud prevention checks with any credit reference agency to
confirm details on this application.

I/We hereby consent to the Bank requesting the relevant credit information on my/our creditworthiness from any Credit Bureau.

I/We consent to the Bank providing Credit Reference Agencies with regular updates, including how I/we manage my/our account.

I/We consent to the Bank disclosing my personal and financial information to relevant Credit Agencies nationally and internationally.

I/We declare that all information provided is true and correct.

Signature of Applicant

Date D D / M M / Y Y Y Y

Applicant to Initial:

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Bidvest Bank Limited (Reg No 2000/006478/06) is an authorised financial services, FSP no 25466, and registered credit provider, NCRCP17. 29/03/2021 7