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Juristic Application For Finance

Authorised Signatories as per resolution

Name:

ID no:

Designation:

Indicate if prepared to guarantee facility/deal

Full Names and ID No. of all Directors/Membery/Partners/Trustees

Name:

ID No.:

Yes/No

Share %:

Foreign Controlled ?

Instalment Sale:

Lease

Rental

Term Loan

Percentage ?

Period:

Contact Person:

NACM Rate: %

Designation:

Do you require a fuel and Maintenance Facility?

Applicant's Financial Details

Proposed Rate:

Fixed

Linked

Extras Description:

Dealer VAPS Description:

Delivery Fee

Initial Fueling Charges

License and Registration Costs

Initiation Fees to be financed?

Less Deposit/Initial Rental

Sourse of Deposit:

TOTAL

ID Passport No:

Applicant's Income Details

Sourse of Income:

Applicants Expenses per month

Total Monthly Expenses

Date Remuneration Received:

Are you currently liable as:

Surety

Guarantor

Co-debtor

Specify Details:

Confirmation

I/We the undersigned hereby authorise this Credit Provide to contact my/our Bankers and/or auditors and I/we authorise my/our bankers/auditors to disclose to this Credit Provider, details and copies of my/our accounts and financial statements.
I/We the undersigned hebery consent to this Credit Provider making enquiries my/our credit history with any credit bureau. The Bankers/Auditors may disclose confidentail information regarding my/our accounts and financial position to this Credit Provider and provide them with coples of my/our financial statements.
I/We do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.
I/We confirm herewith that I/we are duly authorized to consent to the above.

Signature

Name:

Designation:

Date:

I confirm that:
A. I am not a minor.
B. I have never been deciared mentally unfit by a court.
C. I am not subject to an Administration Order.
D. I do not have any current application pending for debt restructuring or alleviation.
E. I do not have any current debt re-arrangement in existence.
F. I have not previously applied for a debt re-arrangement.
G. I am not under sequestration.
H. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.

If any of the above is incorrect, state which and give details:

I. I would like to be included in any Telemarketing Campaign.

J. I would like to be included in any Marketing List that you may sell or distribute.

K. I would like to be included in any mass distribution of emails or SMS messages.

I understand that I will be liable for a monthly service fee.
I hereby consent to this Credit Provider making enquiries regarding my credit history with any credit bureau.
I consent to this Credit Provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider's obligation under the National Credit Act.
I hereby deciare that the information provided by me is true and correct.

Signature of Applicant: I hereby declare that the details furnished above are true and correct.

Current Date:

Click below to attach copies of: ID, Driver's License, Payslip, 4 months bank stamped bank statements and proof of current residential address not older than 3 month.

ID Document

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Bank Statements

Select

Driver's License

Select

Proof of Address

Select

Payslip

Select

Security

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