Personal Details

Which salesman did you deal with?

ID Number *

Full Name And Surname *

Email Address *

Home Number

Cell Number *

Period At Current Address *

Residential Address

Banking Details

Bank Name *

Branch *

Account Number *

Account Type *

Existing Vehicle Finance With Credit Provider

Bank

Vehicle

Monthly Instalment

Amount To Be Settled

Employment Details

ID Number *

Occupation *

Work Contact Number*

Period At Employer *

Work Address

Marital Details

Divorced Married Single Widowed

ANC/COP

Date Married

Spouse ID Number

Spouse Name

Details Of Person Not Living With You

Name *

Surname *

Relationship *

Contact Number *

Email address *

Residential Address

Home Ownership

Do you own property? *

Which bank is it bonded with?

Is it a joint amount?

Outstanding bond amount?

Current value of property?

Income Details

Gross Salary *

Nett Salary *

Additional income (going into your bank account)

What is the source of the additional income

Expenses

Bond / Rent

Rate / Water / Electricity

Vehicle instalment (Excluding trade-in)

Personal loan repayment

Credit card repayment

Furniture accounts

Overdraft repayment

Policy / Insurance payment

Telephone payment

Transport costs

Food & Entertainment

Education Costs

Loan Details

What term would you like it to be submitted over?

Do you want a residual/balloon payment on your final instalment?

Would you pay a deposit? If so, how much?

By ticking the confirmation tick box below you consent to all related parties for the collection and use of this information. *

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