APPLICANT - Nedbank
APPLICATION FOR A HOME LOAN FOR PRIVATE INDIVIDUALS
Tick () applicable block(s) and complete where necessary
Indicate:
New Loan
Pre-Approval
FOR BANK USE ONLY: COMPULSORY APPLICATION REFERENCE NUMBER
Take Over
Existing client information details (CIS) to be attached and confirmed by client(s)
Employee Number
Lead
Branch of Choice
Name of External Sales Consultant / Branch Staff Member
Tel Number
Estate Agent Name
DCAR Number
Date (ddmmyyyy)
APPLICANT
Existing Home Loan Account Number
State in whose name(s) the mortgage property is registered / to be registered
Title
:
Mr
Mrs Miss
Surname
First Name(s)
Date of Birth
Marital Status
Single
Tribal
Marriage
Dr
Prof
Married ANC Co-habitants
Are you a Namibian citizen?
Yes
No
If No, specify nationality
Do you hold a Namibian permanent residence permit?
If No, specify country of residence
Yes
No
Permanent Residence Nr
Have you ever been declared insolvent?
If Yes, state: Present Postal Address
Yes
No
Date Insolvent
Gender:
Male
Other -
Specify:
Female
Married ICOP
Separated
ANC
Divorced
Separated ICOP
Widowed
Number of dependents
Identity/Passport Number (Non- residents only)*
*Certified copy of passport required
Date Rehabilitated
New Address to which correspondence is to be sent Physical Address
Period at this address (years)
Date when your new address becomes valid
ORG 08/2003
Page 1 of 8
RHL 0003
E-Mail Telephone Numbers
Occupation Employer Period of Employment Commission Earner? Self-employed?
(w )
Fax
Yes Yes
No No
(h) Cell
Employee Number
Does the applicant coincide Years with a job change?
If Yes, specify number of years at previous job
Name of previous employer
Yes
No
ORG 08/2003
Page 2 of 8
RHL 0003
SPOUSE
Gender
:
Male
CO-APPLICANT
Female
Title
Mr
Mrs Miss
Surname
First Name(s)
Date of Birth
Marital Status
Single
Tribal
Marriage
Are you a Namibian citizen?
Yes
If No, specify nationality
Do you hold a Namibian permanent residence permit?
Yes
If No, specify country of residence
Dr
Prof
Married
ANC
Co-habitants
No
No
Permanent Residence Nr Physical Address
SURETY
Other -
Specify
Married
ICOP
Separated
ANC
Divorced
Separated
ICOP
Widowed
Identity/Passport Number (Non- residents only)*
*Certified copy of passport required
E-Mail
Telephone Numbers
Have you ever been declared insolvent? If Yes, state: Occupation Employer Period of Employment Commission Earner? Self-employed?
(w )
Fax
Yes
No
Date Insolvent
(h) Cell
Date Rehabilitated
Yes Yes
No No
Employee Number
Does the applicant coincide Years with a job change?
If Yes, specify number of years at previous job
Name of previous employer
Yes
EXISTING ACCOUNTS APPLICANT
TYPE OF ACCOUNT
NAME OF INSTITUTION
BRANCH
ACCOUNT NUMBER
DATE OPEND
Cheque
Credit Card
Savings/Investment s
SPOUSE / CO-APPLICANT / SURETY
TYPE OF ACCOUNT
NAME OF INSTITUTION
BRANCH
ACCOUNT NUMBER
DATE OPEND
Cheque
Credit Card Savings/Investment s
No
BALANCE BALANCE
ORG 08/2003
Page 3 of 8
RHL 0003
INCOME AND EXPENDITURE
INCOME
Gross Basic Salary (including bonus) N$
Fringe Benefits
N$
Other Income (specify)
N$
Total Income
N$
Less Deductions (pension fund, VAT,
etc)
N$
Net Salary
N$
Gross Salary of Spouse / Co-
applicant
N$
Less Deductions (pension fund, VAT,
etc)
N$
Net Salary of Spouse / Co-applicant
N$
Other Income (specify)
N$
Total Net Income
N$
EXPENDITURE
House
Bond (if purchase of a new property is involved, quote future repayment) N$
Rates, taxes, water and lights
N$
Insurance on House/Vehicles
N$
Vehicle Instalment / Lease
Instalment Sale/Lease
N$
Petrol and maintenance
N$
Insurance
Life/Endowments/Annuities
N$
Other instalments/ maintenance
payments, etc.
Parking/Armed Response/M-Net
N$
Housekeeping
Groceries and clothing
N$
Domestic Wages
N$
Education/Crech?/Day Care/Child
Support
N$
Entertainment
N$
Other Accounts (Telephone/Cell &
Land Line)
N$
Total Expenditure
N$
Net Surplus Income
N$
ASSETS Fixed Property (existing) Vehicles (year, make & model) Cash Investments / Shares Other (specify) TOTAL
SPECIFY N$ N$ N$ N$ N$ N$
LIABILITIES Mortgage HP Facility Overdraft Retail Accounts
ORG 08/2003
INSTITUTION N$ N$ N$ N$
Page 4 of 8
VALUE VALUE
RHL 0003
Other (specify)
N$
TOTAL
N$
LOAN DETAILS
Purpose for which loan is required
Loan Required: Amount
N$
Interest Rate
Period over which loan is to be repaid
Monthly instalment (discuss with bank)
State how instalment will be paid
Purchase Price of Mortgage Property
Debit Order Other (specify)
N$
Date Purchased (ddmmyyyy)
Bond to be Registered (discuss with
bank)
N$
Type of Loan (Product) (discuss with bank)
1. Standard Home Loan Product
2. Special Home Loan Product (state)
Name of Company Housing Loan Scheme (if applicable)
Collateral / Guarantee Amount
N$
% p a Months
Salary Stop Order
(when applicable)
COMPLETE IF A BOND IN FAVOR OF A THIRD PARTY IS TO BE REGISTERED
Name of Bondholder
Amount of Bond
N$
Monthly Instalment
N$
IF FURTHER LOAN/RE-ADVANCE REQUIRED (Complete only if applying for a further loan/ re-advance)
Has this property been sold to anyone on terms under instalment sale?
Yes
No
If yes, give details and date of sale
MORTGAGE PROPERTY INFORMATION
Type of security (ie property description)
Freehold
Dwelling
Vacant
Land
Sectional
Title Unit
Will the property be permanently occupied throughout the year?
Erf Number Street Number City / Town
Yes
No
Other
(specify)
Suburb/Towns hip
Street Name
Residential for Business use
ORG 08/2003
Page 5 of 8
RHL 0003
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