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

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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

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 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

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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$

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VALUE VALUE

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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

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