Braamfin Personal Loans - APPLICATION FORM

[Pages:1]Braamfin Personal Loans - APPLICATION FORM

IDENTITY NUMBER (one figure per block)

Surname: First Name:

Self: Spouse:

Marital Status:

Single

Married

RESIDENTIAL ADDRESS: (Physical)

Applicant Information

Divorced

Widow POSTAL ADDRESS

Title: A.K.A A.K.A Number of Dependants:

Suburb: Postal Code

Postal Code

Contact No. (Home) E-mail: Language Preference:

English

Afrikaans

Cellular No. Zulu

Employment Information

Employer:

Self:

Start Date: D D M M Y Y Y Y

Occupation: Tel (W):

Employee No.

EXT

Fax:

Tel (HR):

EXT

Work Address

Salary Date:

Net Income after deductions R

.

Frequency: Monthly Is salary paid to bank?

Fortnightly

YES

NO

Weekly

Suburb: Postal Code

Are you currently under Debt Review, Debt Counselling or under Administration

YES

NO

Spouse:

Employer:

Occupation:

Tel (W):

EXT

Tel (C):

Net Income

R

.

Banking Details

Name of Bank Account Type: Mark applicable with "X"

Cheque

Savings

Branch Transmission

Account Number

Overdraft Facility

Name Surname Relationship Telephone No.

R

.

RELATIVES (Details of Relative not living with you *Strictly NO Friends)

1

2

HWC

HWC

Where did you see our advert

I hereby consent African Advantage to perform a credit check when assessing the application. DECLERATION: I declare that the information in this form is true and correct

Applicant Signature

Date D D M M Y Y Y Y

IT IS A SERIOUS OFFENCE TO MAKE A FALSE DECLARATION

FAX APPLICATION AND DOCUMENTS TO: (011) 483-3744

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