Unit 6, 2 Bishop Road, Pinetown

Postnet Suite 512, Private Bag X4,

Kloof, 3640
TEl: (031) 701 6660
National: 0861 CARTIME
E-mail: info@cartime.co.za
FRANCHISEE APPLICATION FORM

PREAMBLE
Completion of this Confidential Questionnaire does not obligate either CARtime or the applicant in any way.. Should
you be a member of a company or partnership, each member of the entity must complete this form in full, each
with a copy of their ID and proof of residence.

PERSONAL INFORMATION
Surname: ____________________________________________________________________

First Name(s): ____________________________________________________________________

CONTACT DETAILS:

Cell phone: ___________________________Work Tel:_________________________________

E-mail Address: __________________________________________________________________

Declaration of financial information:

Assets

Description
Immovable properties (eg house) At Cost Present Value

Investments (shares in listed companies, With which institution Present Value

investment accounts)

Pension/Provident fund (if any):

Bank accounts (incl savings)

Motor vehicles

Total Assets R

HEAD OFFICE: UNIT 6, 2 BISHOP ROAD, PINETOWN | 031 701 6660

 Unit 6, 2 Bishop Road, Pinetown
Postnet Suite 512, Private Bag X4,
Kloof, 3640
TEl: (031) 701 6660
National: 0861 CARTIME
E-mail: info@cartime.co.za

Liabilities

Description
Mortgage bonds Repayment amount Balance

Vehicle finance

Credit cards

Other personal loans

Total Liabilities R

Net Asset value: (Assets less Liabilities): _R__________________________________

HEAD OFFICE: UNIT 6, 2 BISHOP ROAD, PINETOWN | 031 701 6660

 Unit 6, 2 Bishop Road, Pinetown
Postnet Suite 512, Private Bag X4,
Kloof, 3640
TEl: (031) 701 6660
National: 0861 CARTIME
E-mail: info@cartime.co.za

Monthly expenses:

Description Amount
Pension / savings contributions
Medical aid
Rates and taxes
Bond repayments
Vehicle finance payments
Personal Loan repayments
Long term insurance (life)
Short term insurance (cars, house)
School fees
Travel expenses
Monthly groceries (est)
Monthly entertainment
Mobile phone(s)
Wifi/internet at home
Other:

Total monthly outflows: R

I hereby declare I am not an unrehabilitated insolvent, nor have I been declared insolvent or have any
judgements against me, of a financial nature.

I hereby declare I do not have a criminal record in respect to any financial nature or any other, that may
impede or restrict my ability to sign a surety or lease or enter any contract in my personal capacity.

I declare the information above to be true and correct, and fairly represent my financial position, at this
point in time.

Name: ________________________________ Signature: _____________________________

HEAD OFFICE: UNIT 6, 2 BISHOP ROAD, PINETOWN | 031 701 6660