LOAN APPLICATION FORM - Loans For Blacklisted People
LOAN APPLICATION FORM
Plse complete and fax/email back to us with latest salary advice, 3 mnth bank statement, and a clear id copy
PERSONAL LOAN: FURNITURE FINANCE:
Chain Details
BROKER NAME
HOME IMPROVEMENT : CAR FINANCE:
Personal Quick Check Details
Title
Surname
Second name
Home Tel Number
Work Tel Number
Marital Indicator
Never Married
Married
How Married?
Antenup Contract
Comm of Property
How many dependants do you have
Are you under Administration, Sequestration, Liquidation or Debt Counselling?
Address Details
Residential Address Line 2 Suburb City Postal Code
Home Owner
AGENT NAME
LOAN AMOUNT: Merchant Code
Language
Divorced Single
First Name ID Number Cellphone Number Extension Widowed Tribal
EMAIL: FAX:
Ethnic Group
Yes No
Renting
Postal Address Line 2 Suburb City
Postal Code
Employment Details
Employment Status
Perm
Date Employed
Department
Salary Frequency
MFW
Employers Adress
Spouse Details
Title
Second Name
Gross Salary
R
Employer Name
Income and Expenses
Basic Salary Overtime Permanent Allowances Bonus Other Income
Contract
IF SALARY DATE FALLS ON WEEKEND OR
public holiday when do
do you get paid?
Occupation
Salary Pay Date
Surname
Gender
NB! Net Salary R
Work Tel:
Male
Female
only your own individual expenses
Bond/Rent not on bank statement Rates, Water, Electricity Groceries Transoprt & Petrol
Education and School Fees Telephone - Cellphone
Retail - Clothing - Furniture accounts Other Expenses
Employer HR Contact Person HR Contact Number Employee Number
First Name
ID No
Other Income
R
Cell Number:
Bank Name:
Branch Name: Branch Code: Acc Type: Acc No:
Next of Kin not staying at same address than applicant
Friend / Relative 1
Title
Surname
Firstname
Relationship
Work Number
Home Number
Cell Number
Physical Adress
Friend / Relative 2 Work Number
Title
Surname
Home Number
Firstname
Cell
Physical Address
Acknowledgement, Consent and Authorisation by Applicant
TO BE READ AND UNDERSTOOD BY THE FINANCE APPLICANT BEFORE SIGNING
- Make any reasonable enquiries to confirm the details provided in this application - Access the files of any credit bureau, third party or any other relevant database to obtain my credit records which may be relevant to this application : Signature:
Date:
Relationship
................
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