• Cnr C.R. Swart & Ontdekkers Roodepoort, 1724
  • 010 823 8950
APPLICATION FOR INSTALMENT FINANCE-PG1
GOODS DESCRIPTION: MODEL: MAKE:
DEALER/BRANCH: Hyundai Roodepoort
CNR C.R. SWART & ONTDEKKERS, ROODEPOORT
TEL NO.: 010 823 8950
LICENCE/REG: 5016
DEPOSIT/TRADE IN: OTHER: RESIDUAL:
PERSONAL DETAILS TITLE: SURNAME: ID NO.:
FULL NAMES: INITIALS: DEPENDANTS:
MALEFEMALE MARRIED ANCCOPSINGLEWIDOWED DATE MARRIED:
HOME ADDRESS: PERIOD:
TEL(H): TEL(W): CELL: FAX: EMAIL:
POSTAL ADDRESS (if different from home address): CODE:
PREVIOUS ADDRESS: PERIOD (How long at address?):
SPOUSE NAMES: SPOUSE ID:
NEXT OF KIN (not living with you): RELATIONSHIP:
ADDRESS: TEL:
EMPLOYER DETAILS EMPLOYER: OCCUPATION:
EMPLOYER ADDRESS: TEL: NO. OF YEARS:
SALARY DATE: PREVIOUS EMPLOYER: NO. OF YEARS:
SPOUSE EMPLOYER: NO. OF YEARS:
SPOUSE TEL: SPOUSE OCCUPATION:
BANK DETAILS BANK NAME: BRANCH NAME: BRANCH CODE:
NAME OF ACCOUNT HOLDER: ACCOUNT NO.:
ETHNIC GROUP AFRICANCOLOUREDINDIANWHITEOTHER
LANGUAGE PREFERENCE ENGLISH (PRIMARY)AFRIKAANS (FOR EXPLANATORY VERSION)OTHER
APPLICATION FOR INSTALMENT FINANCE-PG2
PERSONAL APPLICATION FORM OWN SPOUSE
BASIC MONTHLY (EXCL CAR ALLOWANCE)
CAR ALLOWANCE
TOTAL SALARY (BASIC & CAR ALLOWANCE)
MONTHLY COMMISSION
NET TAKE HOME PAY
INCOME OTHER THAN SALARY/WAGES**
SOURCE OF OTHER INCOME**
 
TOTAL MONTHLY HOUSEHOLD INCOME (NET SALARY & OTHER) R
 
HOUSEHOLD EXPENSES PER MONTH      
BOND PAYMENT / RENT RATES, WATER AND ELECTRICITY
VEHICLE INSTALMENTS (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
HOUSEHOLD EXPENSES OTHER
TOTAL MONTHLY HOUSEHOLD EXPENSES
HOUSEHOLD SURPLUS/DISPOSABLE INCOME
ARE YOU CURRENTLY LIABLE AS SURETYGUARANTORCO-DEBTOR
SPECIFY DETAILS
IF YOU HAVE SIGNED SURETY OR CO-DEBTOR PLEASE INDICATE THE FULL AMOUNT OUTSTANDING:
PLEASE TICK YOUR PREFERRED METHOD OF COMMUNICATION ALLEMAILPOSTTELEPHONESMS
 
I confirm that:

  1. I am not a minor.
  2. I have never been declared mentally unfit by a court.
  3. I am not subject to an administration order.
  4. I do not have any current application pending for debt restructuring or alleviation.
  5. I do not have any current debt re-arrangement in existence.
  6. I have not previously applied for a debt re-arrangement.
  7. I am not under sequestration.
  8. 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:
  9. I hereby grant the Credit Provider the right to communicate with me through any electronic/written media of verbally in order to make available to me, their product offering.

YESNO

 

I hereby give consent to the Credit Provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the application. I also give consent to the Credit Provider to share my payment behaviour with any credit agency.

I hereby give consent to the Credit Provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the credit application and / or application for insurance.
I hereby declare that all of the above information is true and correct.

Signature (Type Your Full Name): Date: