6+

FIRST NAME MIDDLE NAME

SURNAME

ID NUMBER PASSPORT (NON RSA)

LANGUAGE ENGLISH GENDER MALE

AFRIKAANS FEMALE
TITLE MR MRS MISS DR PROF ADV REV RACE/ETHNIC GROUP CAUCASIAN COLOURED
AFRICAN ASIAN
NATIONALITY GRADUATE YES / NO
MARITAL STATUS SINGLE MARRIED DIVORCED WIDOW/ER MARITAL CONTRACT ANC / COP TRADITIONAL
DATE MARRIED Y Y Y Y / M M / D D
MOBILE NUMBER MOBILE TYPE CONTRACT / PREPAID
HOME NUMBER
E-MAIL ADDRESS WORK NUMBER
SPOUSES DETAILS
SPOUSES NAME SPOUSES SURNAME

SPOUSES ID
SPOUSES NUMBER
RESIDENTIAL DETAILS
RESIDENTIAL ADDRESS POSTAL ADDRESS

RESIDENTIAL SUBURB POSTAL SUBURB

POSTAL CODE POSTAL CODE

HOME TENANT LODGER OWNER BOND & OUTSTANDING AMT YES / NO R

PERIOD AT ADDRESS YEARS MONTHS BONDED VIA WHICH BANK

PERIOD AT PREVIOUS ADDRESS YEARS MONTHS PROPERTY VALUE R

EMPLOYER DETAILS
EMPLOYER NAME OCCUPATION

INDUSTRY TYPE PERIOD EMPLOYED YEARS

EMPLOYER ADDRESS MONTHS

EMPLOYER SUBURB PERIOD AT PREVIOUS YEARS

POSTAL CODE EMPLOYER MONTHS
SELF EMPLOYED
SOLE TRADER SOLE PROPRIETOR / FARMER COMPANY YEAR END MONTH
APPLICANT INCOME DETAILS SPOUSE INCOME
GROSS REMUNERATION R , 0
MONTHLY COMMISSION R , 0 GROSS REMUNERATION R
CAR ALLOWANCE R ,
OVERTIME R , NET TAKE-HOME PAY R
TOTAL R ,
NET TAKE-HOME PAY R , 0

OTHER INCOME R ,
SPECIFY OTHER INCOME

CLIENT INITIAL
 APPLICANT'S EXPENSES SPOUSE'S EXPENSES
BOND PAYMENT R , R
RENT R , R ,
RATES, WATER & ELECTRICITY R , R ,
PERSONAL LOAN R , R ,
CREDIT CARD R , R ,
FURNITURE ACCOUNTS R , R ,
CLOTHING ACCOUNTS R , R ,
OVERDRAFT REPAYMENTS R , R ,
POLICY/INSURANCE PAYMENTS R , R ,
TELEPHONE PAYMENTS R , R ,
TRANSPORT COSTS R , R ,
FOOD R , R ,
ENTERTAINMENT R , R ,
EDUCATION COSTS R , R ,
MAINTENANCE R , R ,
HOUSEHOLD EXPENSES R , R ,
VEHICLE INSTALMENTS (EXCL
R
INSTALMENTS TO BE SETTLED) , R ,
OTHER EXPENSES R , ,
TOTAL EXPENSES R , ,
NEAREST RELATIVE / FRIEND DETAILS - NOT LIVING WITH YOU
FIRST NAME SURNAME

RELATION PHONE NUMBER

RELATIVE ADDRESS 1 RELATIVE ADDRESS 2
RELATIVE SUBURB POSTAL CODE
APPLICANT BANKING DETAILS
BANK NAME BANK BRANCH / CODE
ACCOUNT NUMBER
ACCOUNT TYPE CHEQUE SAVINGS
CHOOSE A DATE OF FIRST 1 2 3 4 5 6 7 8 9 10 11
TRANSMISSION
INSTALMENT 12 13 14 15 16 17 18 19 20 21 22
23 24 25 26 27 28 29 30 31

SETTLING EXISTING VEHICLE INSTALLMENT

BANK NAME MONTHLY INSTALMENT R
ACCOUNT NO SETTLEMENT AMOUNT R
BANK STATEMENT CONSENT
I/WE PROVIDE MY/OUR EXPRESS CONSENT TO THE CREDIT PROVIDER TO REQUEST BANK STATEMENTS ELECTRONICALLY IN RESPECT OF THE BANK
ACCOUNT/S LISTED ON THE APPLICATION FORM AND PROCESS MY/OUR PERSONAL INFORMATION (AS DEFINED IN THE LEGISLATION) FOR THE
SOLE PURPOSE OF APPLYING FOR VEHICLE/ASSET FINANCE
ABSA BANK LTD, FIRSTRAND BANK LTD, NEDBANK LTD AND STANDARD BANK LTD (THE BANKS) WORK WITH EACH OTHER AND OTHER FINANCIAL
INSTITUTIONS TO FIGHT, AMONGST OTHER CRIMES, FINANCE APPLICATION FRAUD. IN THESE DEALINGS, THE BANKS ENSURE THAT ALL PERSONAL
AND FINANCIAL INFORMATION ABOUT CLIENTS ARE PROTECTED AND KEPT STRICTLY CONFIDENTIAL.
YES NO SIGN:
CONSENT
DO YOU REQUIRE INSURANCE QUOTES? YES NO DO YOU CONSENT FOR CREDIT CHECKING? YES NO
MARKETING CONSENT LIABILITY DETAILS
DO YOU CONSENT FOR YOUR DETAILS ARE YOU CURRENTLY LIABLE AS A SURETY? YES NO
YES NO
TO BE SHARED WITHIN OUR COMPANY? ARE YOU CURRENTLY LIABLE AS A GUARNATOR? YES NO
DO YOU CONSENT FOR YOUR DETAILS ARE YOU CURRENTLY LIABLE AS A CO-DEBTOR? YES NO
YES NO
TO BE SHARED AMONGST OUR PARTNERS? ARE YOU UNDER DEBT REVIEW? YES NO
DO YOU CONSENT TO RECEIVE ARE YOU UNDER ADMINISTRATION ORDER? YES NO
YES NO
 YES NO
MARKETING INFORMATION? ARE YOU UNDER A SEQUESTRATION ORDER? YES NO
CLIENT SIGNATURE DATE WITNESS
APPROVAL VALID FOR 7 DAYS FROM DATE OF SUBMISSION
 APPLICANT DETAILS
FIRST NAME MIDDLE NAME

SURNAME

ID NUMBER PASSPORT (NON RSA)

LANGUAGE ENGLISH GENDER MALE

AFRIKAANS FEMALE

TITLE MR MRS MISS DR PROF ADV REV RACE/ENTHNIC GROUP WHITE COLOURED
BLACK ASAIN
NATIONALITY GRADUATE YES / NO

MARITAL STATUS SINGLE MARRIED DIVORCED WIDOW/ER MARITAL CONTRACT ANC/COP TRADITIONAL
DATE MARRIED Y Y Y Y / M M / D D
MOBILE NUMBER MOBILE TYPE CONTRACT / PREPAID
HOME NUMBER
E-MAIL ADDRESS WORK NUMBER

SPOUSES DETAILS
SPOUSES NAME SPOUSES SURNAME

SPOUSES ID
SPOUSES NUMBER

RESIDENTIAL DETAILS
RESIDENTIAL ADDRESS POSTAL ADDRESS

RESIDENTIAL SUBURB POSTAL SUBURB

POSTAL CODE POSTAL CODE

OWNER/TENANT/LODGER
PERIOD AT ADDRESS YEARS MONTHS BONDED VIA (BANK)
PERIOD AT PREVIOUS ADDRESS YEARS MONTHS PROPERTY VALUE R

EMPLOYER DETAILS
EMPLOYER NAME OCCUPATION

INDUSTRY TYPE PERIOD EMPLOYED YEARS

EMPLOYER ADDRESS MONTHS

EMPLOYER SUBURB PERIOD AT PREVIOUS YEARS

POSTAL CODE EMPLOYER MONTHS

APPLICANT INCOME DETAILS SPOUSE INCOME

GROSS REMUNERATION R ,
MONTHLY COMMISSION R , GROSS REMUNERATION R
CAR ALLOWANCE R ,
OVERTIME R , NET TAKE-HOME PAY R
TOTAL R ,
NET TAKE-HOME PAY R ,

OTHER INCOME R ,
SPECIFY OTHER INCOME
 CLIENT INITIAL
APPLICANT EXPENSES
BOND PAYMENT R ,
RENT R ,
RATES, WATER & ELECTRICITY R ,
PERSONAL LOAN R ,
CREDIT CARD R ,
FURNITURE ACCOUNTS R ,
CLOTHING ACCOUNTS R ,
OVERDRAFT REPAYMENTS R ,
POLICY/INSURANCE PAYMENTS R ,
TELEPHONE PAYMENTS R ,
TRANSPORT COSTS R ,
FOOD R ,
ENTERTAINMENT R ,
EDUCATION COSTS R ,
MAINTENANCE R ,
HOUSEHOLD EXPENSES R ,
VEHICLE INSTALMENTS (EXCL
R
INSTALMENTS TO BE SETTLED) ,
OTHER EXPENSES R ,
R ,
R ,

NEAREST RELATIVE / FRIEND DETAILS - NOT LIVING WITH YOU

FIRST NAME SURNAME

RELATION PHONE NUMBER

RELATIVE ADDRESS 1 RELATIVE ADDRESS 2

RELATIVE SUBURB POSTAL CODE

APPLICANT BANKING DETAILS

BANK NAME BANK BRANCH / CODE
ACCOUNT NUMBER
ACCOUNT TYPE CHEQUE SAVINGS
CHOOSE A DATE OF FIRST 1 2 3 4 5 6 7 8 9 10 11
TRANSMISSION
INSTALMENT 12 13 14 15 16 17 18 19 20 21 22
23 24 25 26 27 28 29 30 31

SETTLING EXISTING VEHICLE INSTALLMENT

BANK NAME MONTHLY INSTALMENT R
ACCOUNT NO SETTLEMENT AMOUNT R

CONSENT
DO YOU REQUIRE INSURANCE QUOTES? YES NO DO YOU CONSENT FOR CREDIT CHECKING? YES NO
MARKETING CONSENT LIABILITY DETAILS
DO YOU CONSENT FOR YOUR DETAILS ARE YOU CURRENTLY LIABLE AS A SURETY? YES NO
YES NO
TO BE SHARED WITHIN OUR COMPANY? ARE YOU CURRENTLY LIABLE AS A GUARNATOR? YES NO
DO YOU CONSENT FOR YOUR DETAILS ARE YOU CURRENTLY LIABLE AS A CO-DEBTOR? YES NO
YES NO
TO BE SHARED AMONGST OUR PARTNERS? ARE YOU UNDER DEBT REVIEW? YES NO
DO YOU CONSENT TO RECEIVE ARE YOU UNDER ADMINISTRATIO ORDER? YES NO
YES NO
MARKETING INFORMATION? ARE YOU UNDER A SEQUESTRATION ORDER? YES NO
 CLIENT SIGNATURE DATE WITNESS
APPROVAL VALID FOR 7 DAYS FROM DATE OF SUBMISSION
 APPLICANT DETAILS
FIRST NAME MIDDLE NAME

SURNAME

ID NUMBER PASSPORT (NON RSA)

LANGUAGE ENGLISH GENDER MALE

AFRIKAANS FEMALE

TITLE MR MRS MISS DR PROF ADV REV RACE/ENTHNIC GROUP WHITE COLOURED
BLACK ASAIN
NATIONALITY GRADUATE YES / NO

MARITAL STATUS SINGLE MARRIED DIVORCED WIDOW/ER MARITAL CONTRACT ANC/COP TRADITIONAL
DATE MARRIED Y Y Y Y / M M / D D
MOBILE NUMBER MOBILE TYPE CONTRACT / PREPAID
HOME NUMBER
E-MAIL ADDRESS WORK NUMBER

SPOUSES DETAILS
SPOUSES NAME SPOUSES SURNAME

SPOUSES ID
SPOUSES NUMBER

RESIDENTIAL DETAILS
RESIDENTIAL ADDRESS POSTAL ADDRESS

RESIDENTIAL SUBURB POSTAL SUBURB

POSTAL CODE POSTAL CODE

OWNER/TENANT/LODGER
PERIOD AT ADDRESS YEARS MONTHS BONDED VIA (BANK)
PERIOD AT PREVIOUS ADDRESS YEARS MONTHS PROPERTY VALUE R

EMPLOYER DETAILS
EMPLOYER NAME OCCUPATION

INDUSTRY TYPE PERIOD EMPLOYED YEARS

EMPLOYER ADDRESS MONTHS

EMPLOYER SUBURB PERIOD AT PREVIOUS YEARS

POSTAL CODE EMPLOYER MONTHS

APPLICANT INCOME DETAILS SPOUSE INCOME

GROSS REMUNERATION R ,
MONTHLY COMMISSION R , GROSS REMUNERATION R
CAR ALLOWANCE R ,
OVERTIME R , NET TAKE-HOME PAY R
TOTAL R ,
NET TAKE-HOME PAY R ,

OTHER INCOME R ,
SPECIFY OTHER INCOME
 CLIENT INITIAL
APPLICANT EXPENSES
BOND PAYMENT R ,
RENT R ,
RATES, WATER & ELECTRICITY R ,
PERSONAL LOAN R ,
CREDIT CARD R ,
FURNITURE ACCOUNTS R ,
CLOTHING ACCOUNTS R ,
OVERDRAFT REPAYMENTS R ,
POLICY/INSURANCE PAYMENTS R ,
TELEPHONE PAYMENTS R ,
TRANSPORT COSTS R ,
FOOD R ,
ENTERTAINMENT R ,
EDUCATION COSTS R ,
MAINTENANCE R ,
HOUSEHOLD EXPENSES R ,
VEHICLE INSTALMENTS (EXCL
R
INSTALMENTS TO BE SETTLED) ,
OTHER EXPENSES R ,
R ,
R ,

NEAREST RELATIVE / FRIEND DETAILS - NOT LIVING WITH YOU

FIRST NAME SURNAME

RELATION PHONE NUMBER

RELATIVE ADDRESS 1 RELATIVE ADDRESS 2

RELATIVE SUBURB POSTAL CODE

APPLICANT BANKING DETAILS

BANK NAME BANK BRANCH / CODE
ACCOUNT NUMBER
ACCOUNT TYPE CHEQUE SAVINGS
CHOOSE A DATE OF FIRST 1 2 3 4 5 6 7 8 9 10 11
TRANSMISSION
INSTALMENT 12 13 14 15 16 17 18 19 20 21 22
23 24 25 26 27 28 29 30 31

SETTLING EXISTING VEHICLE INSTALLMENT

BANK NAME MONTHLY INSTALMENT R
ACCOUNT NO SETTLEMENT AMOUNT R

CONSENT
DO YOU REQUIRE INSURANCE QUOTES? YES NO DO YOU CONSENT FOR CREDIT CHECKING? YES NO
MARKETING CONSENT LIABILITY DETAILS
DO YOU CONSENT FOR YOUR DETAILS ARE YOU CURRENTLY LIABLE AS A SURETY? YES NO
YES NO
TO BE SHARED WITHIN OUR COMPANY? ARE YOU CURRENTLY LIABLE AS A GUARNATOR? YES NO
DO YOU CONSENT FOR YOUR DETAILS ARE YOU CURRENTLY LIABLE AS A CO-DEBTOR? YES NO
YES NO
TO BE SHARED AMONGST OUR PARTNERS? ARE YOU UNDER DEBT REVIEW? YES NO
DO YOU CONSENT TO RECEIVE ARE YOU UNDER ADMINISTRATIO ORDER? YES NO
YES NO
MARKETING INFORMATION? ARE YOU UNDER A SEQUESTRATION ORDER? YES NO
 CLIENT SIGNATURE DATE WITNESS
APPROVAL VALID FOR 7 DAYS FROM DATE OF SUBMISSION
NAME

SURNAME

ID NUMBER

MOBILE NUMBER

E-MAIL ADDRESS

RESIDENTIAL ADDRESS

RESIDENTIAL SUBURB

POSTAL CODE
`

VEHICLE

YEAR MODEL

ID NUMBER

Volkswagensure (Hollard)
Miway
Budget
King Price
ABSA iDirect
Outsurance