Finance Application

Fixed property

Stand number

Type (eg house)

Registered owner

Price paid

Current balance

Market value

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PERSONAL DETAILS (Please complete in BLOCK LETTERS. Tick (√) applicable block(s) and complete where necessary.)

SURNAME       FIRST name(s)       Title (Mr/Mrs/Miss/Dr, etc)

Identity/Passport/Temporary resident number       Date of birth (ddmmyyyy)

What is your preferred language?      English      Afrikaans     North Sotho      Sotho
                                                                     Tsonga    Tswana        Venda                   Xhosa       Zulu

if for some reason is not possible for us to communicate with you in your
preferred language, which other language would you prefer?                          English    Afrikaans

Gender    Male     Female      Race (for statistical purposes)       Black     Coloured      Indian     White
Marital status              Single    Married OCOP (inc accrual system)    Married OCOP (excl accrual system)    COP    Divorced
                                       Widowed    Customary-law-marriage    Foreign    Civil union

Residential type         SA citizen    Non-SA resident    Temporary SA resident    Permanent SA resident
Contact details    Tel(w)      Tel(h)      Cell      Email address
Preferred contact no     Home    Work    Cell
Are you an emancipated minor?     Yes      No      if no, are you assisted by your guardian  Yes    No  Are you under an administrative order?  Yes    No
Have you ever been declared insolvent?     Yes      No,   If yes, state the date of insolvency      Date of rehabilitation, if applicable
Do you have a curator bonis?    Yes      No
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ADDRESS DETAILS

Residential address        Postcode
Postal address                 Postcode

Period at this address(years)   Period at previous address(years)
Propery ownership    Living with partner    Living with parents    Owner of property    Rent property
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EMPLOYMENT DETAILS

Type of employment     Self-employed     Commission earner    Casual worker    Contract worker    Pensioner
                                           Unemployed    Salary earner
Present employer     Occupation

Employed since        Number of years at previous employer

Current gross annual income     Estimated future revenue from business

Employee number    Address of present employer
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SPOUSE DETAILS

SURNAME      FIRST name(s)     Title(Mr/Mrs/Miss/Dr)

Identity number

Contact details    Tel(w)      Tel(h)      Cell      Email address

Residential address        Postcode
Postal address                 Postcode
Are you under an administrative order?  Yes    No. Have you ever been declared insolvent?     Yes      No,   If yes, state teh date of insolvency
Date of rehabilitation, if applicable
Do you have a curator bonis?    Yes      No
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NEXT OF KIN

First Name		Surname
Relation		Phone Number
Address		Postal Code

Our group continually strives to provide the best bundle of products and services to suit your new and evolving needs. We would like to be able to inform you of exciting new products and special offers so that you can make the best choices regarding your financial needs. would you like to be informed? Yes No
Our goup sometimes partners with other organisations in an attempt to arrange exclusive deals for our clients' benefit. We would like our partners to present these to you so that you do not miss out on amzing opportinities that could be relevant to your evolving needs. Would you like us to ensure that these opportinuties are presented to you? Yes No
Our goup aims for product and service excellence. However, your valued opinion is needed in order for us to achieve this goal. We contract reputable research organisations to convert our clients' input into relevant suggestions for improvement. Would you like to voice your opinion? Yes No
Please tick which channels you would prefer us to use when communicating the above to you:
All Email SMS Telephone Other

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INITIATION FEE
Do you wish to pay the initiation free upfront, or do you wish to include the initiation fee in the loan?     Upfront      Include in loan
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INSURANCE
If credit life insurance is a credit requirement, please indicate whether you are interested in a quote    Yes      No
  Short-term insurance is a requirement for an instalment agreement/lease agreement. The granting of this loan is therefore conditional upon your compliance with our insurance requirements.
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INCOME AND EXPENDITURE

INCOME		Deductions
Gross monthly basic salary	R	PAYE	R
Travel/Car allowance	R	UIF	R
Housing subsidy/allowance	R	Medical aid	R
Medical aid allowance	R	Pension/Provident	R
Reimbursements		Group insurance	R
Petrol	R	Industry council contributions	R
Cellphone/telephone	R	Union fees	R
Other	R	Total deducations	R
Commission		Net income	R
Month 1	R	EXPENDITURE (Household)
Month 2	R	Total property rental expenses	R
Month 3	R	Rates, taxes, water and electricity	R
Overtime	R	Groceries and clothing	R
Sick pay	R	Domestic wages	R
Leave pay	R	Telephone and cellphone(s)	R
Bonus	R	Entertainment and DSTV	R
Other income		Fuel and maintenance	R
Maintenance	R	Short-term insurance	R
Additional income		Life insurance and annuities	R
Net pension	R	Investments and savings	R
Net disability grant	R	Education and school fees	R
Other	R	Medical expenses (excluding medical aid contribution)	R
Gross property rental income	R	Other	R
		Total expenditure	R
Gross income	R	Surplus Deficit =(Gross income - deducations - expenditure)	R

Contractual long-term liabilities
	Credit povider	Account number	Amount outstanding	Monthly instalment
Vehicle finance			R	R
Home loan			R	R

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Additional Long-term liabilities (not listed above)	Amount outstanding	Monthly instalment
Total vehicle finance debt	R	R
Total home loan debt	R	R
How much vehicle finance debt will you be settling as result of this application?	R	R
How much home loan debt will you be settling as a result of this application	R	R
Total monthly instalment	R	R
Approximate disposable income after contractual liabilities	R	R

Short-term liabilities	Account number	Total limit	Amount outstanding	Monthly instalment
Total overdraft limits including other		R	R	R
Total credit card limit (total liability)		R	R	R
Personal loans		R	R	R
Student Loans		R	R	R
Clothing accounts-total monthly liability		R	R	R
Furniture acccounts-total monthly liability		R	R	R
Other loans		R	R	R

Other liabilities
Have you signed surety for any debt?	Yes No	Specify amount	R
Total monthly liability amount	R

MOVEABLE ASSETS (eg vehicles, furniture)	Market value
	R
	R
	R

INVESTMENT/SHARES (in listed and private institutions)		Market value
Type of investment	Institution held with
		R
		R
		R

LIFE/RETIRMENT POLICIES
Name of assurance company	Cover (eg life, RA, endowment)	Amount of cover	Maturity date	Surrender value
		R		R
		R		R
		R		R

Are you currently under or have you ever applied for debt reiew?	Yes No
Do you have any dispute in process with a credit bureau?	Yes No
Do you have a rearrangement agreement in place with any credit provider as a result of any debt counselling?	Yes No
If married COP, is your spouse currently under or has he/she ever applied for debt review?	Yes No

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BANK ACCOUNT DETAILS (for debit order purposes)
Clearing code Bank name Branch name
Branch code Account number Type of account Cheque Savings Transmision

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DECLARATION

I/We hereby warrant that I/We have fully and truthfully answered all your questions and responded to requests for information as part of this assessment process. I/We hereby confirm that I/We have fully disclosed my/our debt repayment history.

I/We consent to the making enquiries about my/our credit record with credit referance agencies for the purpose of assessing this application or updating my information in future. I/We further consent to Just Group Africa sharing information about how i/we manage this credit agreement with such agencies, who may in turn share this information with other credit providers.

I/We consent to identify and fraud prevention checks and sharing information relating to this application through the South African Fraud Prevention Services.

I have read and understand the terms and conditions and cost of credit.

I hereby declare that the information provided by me is true and correct.