Credit Application Form:
Article Type:	Motor Vehicle
Article New/Used:	New Used
Article Make:	-Please Select Make- ALFA ROMEO AUDI BMW CHEVROLET CHRYSLER CITROEN COLT DAEWOO DAIHATSU DAIMLER FERRARI FIAT FORD HONDA HYUNDAI ISUZU JAGUAR JEEP KIA LADA LAMBORGHINI LANCIA LAND ROVER LEXUS LOTUS MASERATI MAZDA MERCEDES-BENZ MG MINI MITSUBISHI NISSAN OPEL PEUGEOT PORSCHE RANGE ROVER RENAULT ROLLS ROYCE ROVER SAAB SMART SSANGYONG SUBARU SUZUKI TOYOTA VOLKSWAGEN VOLVO
Model:
Year Model:

payment details

Purchase Price: R
Residual Value: %
Repayment Period:	6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96
Agreement:	Instalment Sale Agreement Lease Agreement Rental Agreement Rent2Buy Agreement
Payment Frequency:	Monthly
Rate: %
Rate Indicator:	Fixed Linked

TRADE IN ON CURRENT VEHICLE.

Make:	-Please Select Make- ALFA ROMEO AUDI BMW CHEVROLET CHRYSLER CITROEN COLT DAEWOO DAIHATSU DAIMLER FERRARI FIAT FORD HONDA HYUNDAI ISUZU JAGUAR JEEP KIA LADA LAMBORGHINI LANCIA LAND ROVER LEXUS LOTUS MASERATI MAZDA MERCEDES-BENZ MG MINI MITSUBISHI NISSAN OPEL PEUGEOT PORSCHE RANGE ROVER RENAULT ROLLS ROYCE ROVER SAAB SMART SSANGYONG SUBARU SUZUKI TOYOTA VOLKSWAGEN VOLVO
Model:
Year:
Mielage:
Colour:
Vehicle Finance with:
Settlement Value R:

PERSONAL DETAILS

1. Preferred Language:	English Afrikaans
2. Marital Status:	Single Married Divorced Widow/er Community Of Property Antenuptual Contract Matrimonial Property Act
3. Title:	Advocate Brigadier Captain Colonel Commandant Commissioner Constable Director Doctor Estate Late General Head His Excellency Insolvent Estate Inspector Judge Lieutenant Major Miss Mr Mrs Pastor Professor Doctor Professor Rabbi Reverend Senator Sergeant Sister Superintendent
4. Gender:	Male Female
5. Race/Ethnic Group:	Other African Coloured Indian White
6. Surname:
7. First Name(s):
8. E-mail Address:
9. Identification Type:	Valid Id Passport
10. ID Number:
11. Date of Birth: (CCYYMMDD)
12. Address: Street 1:
Street 2:
Suburb:
City:
Code:
13. Postal Address:
City:
Code:
14. Period at Address: (YYMM)
15. Owner/Tenant/Lodger:	Owner Tenant Lodger
16. Bonded via:
17. Mobile Number:
18. Phone Number: (H)
19. Phone Number: (W)

EMPLOYER DETAILS

20. Occupation:
21. Employer Name:
22. Address:Street 1:
Street 2:
Suburb:
City:
Code:
23. Period Employed: (YYMM)

INCOME DETAILS

Monthly Income:
24. Source of Funds:	Salary Pension Investments Policy Retirement Annuity Donation/Gift Inheritance
25. Gross Remuneration: R
26. Monthly Commission: R
27. Car allowance: R	(Included in Gross)
28. Net Take-home Pay: R
29. Other Income: R
30. TOTAL Income: R
Monthly Expenses:
31. Bond Payment/Rent: R
32. Rates, Water & Electricity: R
33. Vehicle Instalments: R	(Excluding Instalments to be settled)
34. Personal Loan Repayments:
35. Credit Card Repayments: R
36. Furniture Accounts: R
37. Clothing Accounts: R
38. Overdraft Repayments: R
39. Policy/Insurance Payments:
40. Telephone Payments: R
41. Transport Costs: R
42. Food and Entertainment: R
43. Education Costs: R
44. Maintenance: R
45. Household Expenses: R
46. Other: R
47. TOTAL Expenses: R
48. Disposable Income: R
49. Currently liable as:
Surety	No Yes
Guarantor	No Yes
Co-Debtor	No Yes
50. 1st Payment Date:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

BANKING DETAILS

51. Bank Name:
52. Bank Branch:
53. Account Number:
54. Bank Code:
55. Account Type:	Cheque Savings Transmission
56. Pay via Debit Order:	Yes No
57. Settle existing Instalment:	No Yes

SPOUSE DETAILS

58. First Name(s):
59. Identification Type:	Valid Id Passport
60. ID Number:
61. Date of Birth:
62. Phone Number:

RELATIVE DETAILS

63. First Name(s):
64. Relation:
65. Address:
66. Phone Number: