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Application for Instalment Finance
Personal Details
Title *
Initials * Surname * ID No *
Full Names *
Dependants
Date Married
Home Address
Period
Tel (H) *
Cell * Fax
Tel (W) Email *
Postal Address *
Code
Previous Address *
Period
Spouse Names
Spouse ID
Next of Kin
Relationship
Address
Tel
Bond Details
Bond Holder
Amount Outstanding
Property Value R
Instalment R /M Purchase Price
Date Purchased
Registered Renting R
Employer Details
Employer *
Occupation *
Employers Address *
Tel * No of Years
Salary Date *
Previous Employer No of Years
Spouse Employer
No of Years
Tel
Occupation
Salary Details
  Own Spouse Other
Basic Monthly *(excl Car Allow)
Car Allowance
Total Salary Basic & Car Allow
Monthly Commision
Net Take Home Pay
Income other than Salary
Sources of other income
Bank Details
Bank Name *
Branch * Branch Code *
Name of Account Holder * Account number *
Account Type
Household Income
Bond Payment / Rent Rates, Water & Electricity
Vehicle Installments Personal Loan Repayments
Credit Card Repayments Furniture Accounts
Clothing Accounts Overdraft Repayments
Policy / Insurance Payments Telephone Repayments
Transport Costs Food & Entertainment
Education Costs Maintenance
Household Expenses Other
Total Monthly Household Expenses *
Household Surplus / Disposable income *
Are You Currently Liable As:
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If you have signed Surety or Co-Debtor Please Indicate the Full Amount Outstanding
Vehicle Details
Make Model Variant
Year Price Mileage
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