Finance Application Form
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1
2Finance Application
ClientNo
Application Number
Application Date
Individual Applicant
Sole Proprietor
Surety/Co-Debtor
ID Number
Use Block Letters
Tick Appropriate Boxes
Do you require information on insurance ? Yes
No
Instalment
Mobility
Lease
Other
Goods Description
Sale
Plan
Year of Reg
New
Used
M&M Code
For used cars only
AUC
Yes
No
Cash Price
R
Motorplan
R
Mileage
km Extras Amount
R
Accessories
R
km Initial Payment
Motor plan up to
R
Source of Deposit
Deposit
Balloon payment /
Dealer
R
Credit Life/TopUp
R
Residual
Initial Fuelling
Dealer Tel No (
)
Delivery fee
R
R
Charges
License and
Sales Person
Payment
R
R
Registration Costs
Less Deposit/
Contact No
R
Other
R
/Initial Rental
Fax/Email
Extras Description
Special Requirements
Purpose of goods
Business
Private
Total of Extras
R
Debit Order Date
Dealer VAPS Description
Rate
Period
Dealer VAPS Total
R
Initiation Fees to be financed?
Yes
No
Total
R
Date of Birth
Gender M
F
Graduate? Y
N
D
D
M
M
Y
Y
Y
Y
Title
Surname
Spouse name
Names
No. of Depend.
Spouse ID
Marital Status
Single
Married
Divorced
Separated*
Widowed
Verification of marital status: Client Signature
*Spouse's
Contract
ANC
COP*
Outside SA*
Tribal Law*
X
consent
Date Married
Nationality
South African
Other
Country of Residence
D
D
M
M
Y
Y
Y
Y
D
D
M
M
Y
Y
Y
Permit Type
Permit No
Permit Exp Date
Y
Trading as/ Name
Tax no
Vat No
Present Address
Previous Address
Postal Address
Code
Code
Code
Period at Address
Period at Address
Cell No
Y
M
Y
M
Home No
(
)
Email Address
Type of House
House
Flat
Townhouse
Farm
Plot
Caravan/Mobile home
Boarding house/Hostel/Hotel
Next of Kin
Residential Status
Owner
Renter
Living with family
Other
Not living with you
Address
Registered Owner
Self
Spouse
Both
Other
In SA
Home Status
Bonded
Bond-free
Leased
Year Purchased
Current Value
R
Code
Purchase Price
R
Balance Owing
R
Phone No
(
)
Rent / Bond Payment
R
Erf Number
Relationship
Bondholder Name
If a flexi/access bond, total facility granted?
R
Present
Previous
Spouse
Employer
Employer
Employer
Address
Address
Address
Code
Code
Code
Time with Employer
Time with Employer
Y
M
Y
M
Time with Employer
Occupation
Industry
Y
M
Phone
Employed
Full-time
Part-time
Self-employed
Retired
Unemployed
(
)
Basic Salary
R
Spouse Salary
R
Pay Day
Car Allowance
R
Additional Income
R
Regular Monthly Expenses
R
Commission
R
Source of Add Income
R
Initial
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