Finance

Sales Representative -Select Sales Representative (Not Required)- Lourens De Beer Lourika de Bruyn Renier Botha

Title ----- MR. MNR. MISS. MRS. MEV. MS. DR. PROF. PRINCE

Full Names

Cell Number

Sex - Male Female

Number Of Dependants

If you are married, how? - Single Married Divorced Widowed COP ANC

Date of Marriage (dd/mm/yyyy):

Street 1:

Street 2:

Street 3:

Suburb :

City :

Postal Code:

How long have you stayed at this address? (Years/Months):

P.O. Box 1 :

P.O. Box 2 :

P.O. Box 3 :

P.O. Box Suburb :

P.O. Box City :

P.O. Box Postal Code :

Telephone(Home):

Spouse Name(if Married):

Spouse Cell Number(if Married):

Name:

Cell Number:

Address:

Employers Company Name:

Occupation?(What work do you do?):

Employers Address:

Employers Telephone:

Who do you Bank With? - ABSA FNB Nedbank Standard Bank Capitec TYME BANK Other No Bank Details

Bank Branch Name?:

Bank Account Number?

Name of Account Holder

Total Income Before Deductions

Total Income After Deductions

Total Expenses ie Rent, Vehicles, Food, Telephone, Electricity, etc

Bond Payment / Rent

Vehicle Installments

Credit Card Repayments

Clothing Accounts

Insurance Repayments

Transport Costs

Education Costs

Household Expenses

I hereby give consent to the Credit Provider to make enquiries about my credit record with any of credit agencies and to obtain whatever information on me that they might require to process the credit application and / or application for insurance. I hereby declare that all of the above information is true and correct