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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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