Vehicle Request Form
Name:
Surname:
Cell Nr:
Tel Nr:
Email:
Vehicle:

Comment:
* Security Code:

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Finance Application

  
Would you like to apply for finance? Please feel free to complete the finance application form below, which we will submit to the banks on your behalf.
All information you supply will be treated as private and confidential.


<< Back to Vehicle Details

1. PERSONAL DETAILS (Application for Instalment Finance)
1.1 Applicant details
Title :     
First Name :  Surname : 
Second Name/s:  ID Number : 
Language Preference:  Ethnic Group : 
E-mail:  Drivers Licence Nr : 
PO Box Addr:  Home Addr: 
Postal Code:  Nr of Yrs at Home Address: 
Previous Home Address:  Nr of Yrs at Previous Address: 
Gender:  Dependants: 
Marital Status:  Date Married: 
Spouse Name:  Spouse ID Number: 
Occupation:  Total Salary: 
Car Allowance included in Total Salary:  Total Net Income: 
Other Income
(Not Salary/Wages): 		 Source of Other Income: 
Spouse Occupation:  Spouse Total Salary: 
Salary Date: Total Monthly Household Income: 
Employer:  Nr of Yrs at Current Employer: 
Previous Employer:  Nr of Yrs at Previous Employer: 
Spouse Employer:     
1.2 Telephone Numbers
Home:  Work: 
Cell:     
 2. OTHER DETAILS (Application for Instalment Finance)
2.1 Bank Details
Bank Name :  Branch : 
Branch Code :  Type of Account : 
Name of Account Holder :  Account Number : 
2.2 Bond Details
Bond Holder (Institution):  Purchase Price: 
Property Value:  Amount Outstanding: 
Date Purchased:  Instalment: 
Registered:     
2.2.1 Non Registered Bond
Renting:  Monthly Rent: 
2.3 Next of Kin Details
Name :  Surname : 
Contact Number:  Address: 
Relationship:     
 3. VEHICLE DETAILS (Application for Instalment Finance)
3.1 Dealer Details
Dealer / Supplier:  Telephone No.: 
Sales Person:  Fax: 
3.2 Vehicle Description
Make:  Model: 
Purchase Price:  Year of Manufacture: 
Deposit / First Payment:  Expected Instalment: 
4. HOUSEHOLD EXPENSES (Application for Instalment Finance)
4.1 Household Expenses per Month
Rates, Water and Electricity:  Vehicle Instalment
excluding those to be Settled: 
Personal Loan Repayments:  Credit Card Repayments: 
Furniture Accounts:  Clothing Accounts: 
Overdraft Repayments:  Policy/Insurance Repayments: 
Telephone Payment:  Transport Costs: 
Food and Entertainment:  Education Costs: 
Maintenance:  Other: 
Total Household Expenses:  Total Surplus: 

* Security Code:

Submit Application

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