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Warranty & Service Guide
Pre-Approval
Fill in the form below to start your pre-approval process.Â
Step
1
of
18
5%
Application Type:
Individual Applicant
Sole Properietor
Surety/Co-Debtor
Citizenship
SA
Other
(If not SA resident, state country or Residence)
ID/Passport No.
Country of Residence
Permit Type
Permit No.
Country Issued
Issue Date
Expiry Date
Permit Exp Date
Surety ID No.
(If applicable)
Transaction Type:
Sale
Lease
Rental
Lang Pref:
English
Afrikaans
Other
Ethnic Group
African
Black
Coloured
White
Applicant's Details
Title
Initials
Surname
First Name
Middle Name
Gender
M
F
Graduate?
Yes
No
Trading as/Name
Tax No.
VAT NO.
Home Tel No.
Cell No.
Email Address
Home Address:
(Yrs Mnths)
Suburb
Postal Address
(If Different from Residential)
Postal Code
Suburb
Postal Code
Previous Home Address
(Yrs Mnths)
Suburb
Postal Code
Employment Details:
Name
First
Last
Address
Street Address
State / Province / Region
ZIP / Postal Code
Bus Tel No.
Fax No.
Type of industry
Employee No.
Emp Cont No.
Occupation
Previous Employment Details:
Name
Emp Cont No.
Occupation
Address
Street Address
State / Province / Region
ZIP / Postal Code
Home Ownership:
Do you own Property?
Yes
No
If Yes
In your name?
In your Spouse's
Both?
Property Type:
House
Townhouse
Flat
Erf Number
Suburb
Bond/Rental Payment per month:
Bond Amount Outstanding:
Purchase Price
Current Value
If a flexi/access bond, total facility granted?
Bondholder Name
Know Your Client (KYC):
Face to Face On-Site
Face to Face Off-Site
Remote-Other
Dealer Code
Originating Branch
Input Branch
Credit Provider Introducing Branch
Lead Provider
Lead Provider ID No.
Marketers Name
Markert's Code
Marketer's ID No.
Fax No.
Marital Details:
Single
Married
Divorced
Widow
No. of Dependents
Date Married
Spouse's Details:
First
Last
Income
Spouse ID No./DOB
Spouse Employer Name:
Spouse Employer Address:
Street Address
State / Province / Region
ZIP / Postal Code
Marital Agreement
ANC
COP
OTHER
Relative's Details:
(Nearest Relative in SA not living with you)
Relationship
Relative's Tel No.
Name
First
Last
Relative's Address
Street Address
State / Province / Region
ZIP / Postal Code
Landlord's Details:
(Name & Address of Landlord where goods will be kept)
Landlord's Name
Landlord Address
Street Address
State / Province / Region
ZIP / Postal Code
Banking Details:
Account Type:
Cheque
Savings
Transmission
Bank Name
Account No.
Branch Code
Account Holders Name
First
Overdraft Bal:
(If appl)
Limit:
Credit Card Company
Credit Card Number
Cr.Facility Bal:
Straight
Budget
Cr.Facility Limit:
Straight
Budget
Existing &/or a previous Account with credit Provider?
Branch No.
Account No.
Account Name
Installment Amount per month
Number of Installments
Type
Current
Paid up?
To be settled?
Existing accounts with other Credit Providers?
Name of Company
Account No.
Installment Amount per month
Type
Current
Paid up?
To be settled?
Name of Company
Account No.
Installment Amount per month
Type
Current
Paid up?
To be settled?
Individual Applicant
Sole Proprietor
Surety/Co-Debtor
Transaction Details:
Goods Description
Year Model
Salesman
Dealer Name
Dealer Tel No.
Scheme Code
Buyline Code
M&M Code
Period of Contract
(Mnths)
Special Requirements
Balloon Payment R
Balloon Payment %
Residual Value R
Residual Value %
Purpose of Goods:
Business
Private
Taxi
Commerce
Payment Frequency:
Month
Bi-Ann
Quart
Annual
Payment Mode:
Advance
Arrears
Cash
Debit Order
Applicant's Financial Details:
Proposed Rate %
Rates
Fixed
Linked
Selling Price (VAT inclusive)
Extra Description
Total of Extras
Dealer VAPS Description
Delivery Fee
Initial Fuelling Charges
License and Registration Costs
Initiation Feeds to be financed?
Yes
No
Less Deposit/Initial Rental
R
Source of Deposit
Total
ID/Passport No.
Applicant's Income Details:
Gross Remuneration
Monthly Commission
Car Allowance included in Gross
Net Take-home Pay
Income other than Salary/Wages
Source of Income
Total Monthly Income
Applicant's Expenses per month:
Bond Payment/Rent
Rates, Water and Electricity
Vehicle Installments
(excluding those to be settled)
Personal Loans Repayments
Credit Card Repayments
Furniture Accounts
Clothing Accounts
Overdraft Repayments
Policy/Insurance Repayments
Telephone Payment
Transport Cost
Food & Entertainment
Education Costs
Maintenance
Household Expenses
Other
Total Monthly Expenses
Applicant's Disposable Income
Date Remuneration Received:
(DD/MM/YY)
Are you currently liable as:
Surety/Guarantor or Co-debtor
Surety
Guarantor
Co-debtor
Specify Details:
Insurance-Bank VAPS
InSale/Lease-Inside Act
Credit Life Monthly
Cover Pus Monthly
Extended Warranty Term
Other
Rental-Outside Act
Credit Life Monthly
Term
Cover Pus Monthly
Annual
Term
Motor Comprehensive Monthly
Annual
Courtesy Car Monthly
Annual
Service & Maintenance Term
Extended Warranty Term
Other
Comprehensive Vehicle Insurance?
Y/N
Yes
No
Policy No.
Term
Monthly
Annual
Exisiting Ins Co Name
Tel No.
Broker Name
Tel No.
I confirm that: -
(Required)
A. I am not a minor.
B. I have never been declared mentally unfit by a court.
C. I am not subject to an Administration Order.
D. I do not have any current application pending for debt restructing or alleviation.
E. I do not have any current debtre-arrangement.
F. I have not previously applied for a re-arrangement.
G. I am not under sequestration.
H. 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 and give details:
I. I would like to be included in any Telemarketing Campaign.
(Required)
Yes
No
J. I would like to be included in any Marketing List that you may sell or distribute.
(Required)
Yes
No
K. I would like to be included in any mass distribution of emails or SMS messages.
(Required)
Yes
No
I confirm that: -
(Required)
I understand that I will be liable for a monthly fee.
I hereby consent to this Credit Provider making enquiries regarding my credit history with any credit bureau.
I consent to this Credit Provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider's obligation under National Credit Act.
I hereby declare taht the information provided by me is true and correct.
Consent
(Required)
Consent of Applicant
Date
(DD/MM/YY)
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