Apply Now I am applying as:*SelectAn individualA companyAre you blacklisted or ITC listed?*YesNoFor information on the progress of your online application. Please contact Lee-Ann Coetzee: Cell: 076 771 8398 or Email: lee@auctionfinance.co.za Sorry - Auction Finance is unable to assist blacklisted/ITC listed individuals/companies. Do you have your vehicle description avalaible?*SelectYesNoVehicle DetailsVehicle DescriptionM&M CodeYearFirst Date of Registration Current MileageInstalment Sale/Lease AgreementInstalment SaleLease AgreementVehicle Price VAT Incl.Deposit AmountPreferred Finance TermResidual Value/BalloonBudget for Vehicle RepaymentFinance ConsultantPersonal DetailsTitleTitleMrsMrDrProfMsMissFull Names as per ID book*Surname as per ID book*ID No.*GenderGenderMaleFemaleNo. of Dependants*Employment* Private Self-Employed Surety/Co-Debtor Marital Status*Marital StatusMarried (ANC)Married (COP)Married (Tribal Law)SingleWidowedDivorcedDate of Marriage Residential Address* Street Address City Province ZIP / Postal Code Period at Residential Address*Postal Address* Street Address City Province ZIP / Postal Code Cell (1)*Cell (2)Contract/Pre-Paid*ContractPre-PaidTel(Home)FaxEmail Address* Registered for Tax?*Registered for Tax?YesNoTax NumberSpouse DetailsSpouse Full Names as per ID bookSpouse Surname as per ID bookSpouse Contact No.Spouse ID No.Next of Kin (NOT residing with you)N.O.K Full NamesN.O.K SurnameRelationshipContact No.Residential Address Street Address City Province ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Employment DetailsOccupation*Employer's Name*Employer's Industry Sector*Employer's Switchboard Number*Date Employed* Employer's Address* Street Address City Province ZIP / Postal Code Qualifications* Matric Diploma Bachelors Degree Professional Doctorate Other (Specify) Specify:Banking Details - ApplicantBank Name*Branch Name*Branch Code*Name of Account Holder*Account No.*Type of Bank Account*Home OwnershipResidential Status*BondedBond FreeTenantBoarderRegistered UnderYour NameSpouse's NameBothBond Holder (Bank)Date Purchased Purchase PriceAmount OutstandingCurrent House ValueVehicle Finance HistoryDo you have current vehicle finance?*Do you have current vehicle finance?YesNoBank that financed the vehicleMonthly Current Vehicle Instalment Current Trade-in Paid Up Comprehensive InsuranceDo you currently have comprehensive insurance?*Do you currently have comprehensive insurance?YesNoYour current insurance companyIncomeGross Salary*Monthly CommissionCar/Travel AllowanceOther AllowancesOvertimeOvertimeSalary DeductionsAdditional IncomeAdditional Income Source #1Additional Income Source #2Additional Income Source #3Additional Income Source #4Nett Income as per Salary Advice*ExpensesLoan RepaymentVehicle RepaymentInsurance/PoliciesMunicipalHouse Bond/RentCredit CardFurnitureClothingOverdraftSecurity PaymentsTelephoneTransport/FuelFood/EntertainmentEducationSpousal/Child SupportHousehold ExpensesOther Payments #1Other Payments #2Total ExpensesLiability DetailsAre you currently liable as a Surety?*YesNoAre you currently liable as a Guarantor?*YesNoAre you currently liable as a Co-Debtor?*YesNoAre you under debt review?*YesNoAre you under an administration order?*YesNoAre you under a sequestration order?*YesNoAre you insolvent?*YesNoCredit Check Consent DetailsDo you consent for credit checking?*YesNoYour finance application will be vetted by a credit bureauComprehensive InsuranceA value added benefit would be a comparative comprehensive insurance quote to ensure a peace of mind motoring experience*YesNoRequired DocumentsWe require copies of the following documents to process your application: Identity document 3 most recent bank statements 3 most recent salary slips Proof of residence (not older than 3 months) Valid drivers license Would you like to upload these files now? (you can do this at a later stage)*YesNoUpload Files Drop files here or DeclarationI/We hereby declare that the information given in this form is true, complete and accurate. No details were withheld or misrepresented as material facts. I/We know and understand this declaration.I/We confim*I/We confirm the aboveDate* Company DetailsType of Entity*CoCCPartnershipTrustClub/ChurchOtherNo. of trusteesAny trustee a juristic person?YesNoCo/CC/Trust Reg. No.Co/CC/Trust Name (Reg. Name)% Black OwnedTrading NameTax No.VAT No.Holding Company Reg. No.Holding Company NameAddress Street Address City Province ZIP / Postal Code Period at AddressPostal Address* Street Address City Province ZIP / Postal Code *if different from residentialOwner of the property?Are you the owner of the property?YesNoLandlord's DetailsAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Banking DetailsBanker's Name*Branch*Branch Code*Account No.*Name of Auditors/Bookkeepers*Auditor's Contact Person*Auditor's Contact Person Tel.*Annual Turnover*Net Asset Value*Previous or current amounts owing to financial institutionsName #1Account No. #1Instalment Amount #1Balance Owing #1Name #2Account No. #2Instalment Amount #3Balance Owing #2Name #3Account No. #3Instalment Amount #3Balance Owing #3Description of other property registered in company nameStand No.SuburbBonded?Bonded?YesNoBondholder NameBondholder Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Purchase PricePresent ValueDate of Purchase Outstanding Value - BondFinancial DetailsSelling Price (VAT Incl.)Extras Description #1Extras Description Value #1Extras Description #2Extras Description Value #2Extras Description #3Extras Description Value #3Extras Description #4Extras Description Value #4Total of ExtrasSubtotalInsurance Value #1Insurance Value #2Insurance Value #3Less Deposit/Initial RentalPrincipal DebtTrade PriceRetail PriceResidual/Balloon ValueInitiation/Processing Fees to be financed?Processing Fees to be financed?YesNoDealer's InformationDealer CodeOriginal BranchInput BranchCr.Prov.Intr BrnMarketer's CodeNameMarketer's ID No.Fax No.Lead ProviderID No.Buy LineAccount No.SICLanguage of ChoiceLanguage of ChoiceEnglishAfrikaansOtherBusiness DetailsRegistered Office Address* Street Address City Province ZIP / Postal Code No. of Years in Business*Nature of Business*Tel. No.*Fax No.Email Address* Authorised signatories as per resolutionName #1ID No. #1Designation #1Name #2ID No. #3Designation #2Name #3ID No. #3Designation #3Name #4ID No. #4Designation #4Name #5ID No. #5Designation #5Full Names & ID No. of all Directors/Members/Partners/TrusteesYes/No - Prepared to guarentee facility/deal?Name #1ID No. #1Guarantee Deal? #1YesNo%Share #1Name #2ID No. #2Guarantee Deal? #2YesNo%Share #2Name #3ID No. #3Guarantee Deal? #3YesNo%Share #3Name #4ID No. #4Guarantee Deal? #4YesNo%Share #4Name #5ID No. #5Guarantee Deal? #5YesNo%Share #5Name #6ID No. #6Guarantee Deal? #6YesNo%Share #6Name #7ID No. #7Guarantee Deal? #7YesNo%Share #7Name #8ID No. #8Guarantee Deal? #8YesNo%Share #8Name #9ID No. #9Guarantee Deal? #9YesNo%Share #9Name #10ID No. #10Guarantee Deal? #10YesNo%Share #10Foreign Controlled?Foreign Controlled?YesNoPercentage?Contact PersonDesignationTransaction TypeTransaction Type*Instalment SaleLeaseRentalTerm LoanPeriod*NACM Rate % (what we are going to use)*Do you require a fuel and maintenance facility?*YesNoTransaction DetailsSupplier/Dealer NameDealer Tel. NoContact NameTel. No.Goods DescriptionInsurance Company/BrokerPolicy No.Renewal Date Confirmed ByTel. No.DeclarationI/We the undersigned hereby authorise this credit provider to contact my/our bankers and/or auditors and I/We authorise my/our bankers/auditors to disclose to this credit provider, details and copies of my/our accounts and financial statements. I/We the undersigned hereby consent to this credit provider making enquiries regarding my/our credit history with any credit bureau. The bankers/auditors may disclose confidential information regarding my/our accounts and financial position to this credit provider and provide them with copies of my/our financial statements. I/We do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act I/We confirm herewith that I/We are duly authorised to consent to the above.I/We confirm* I/We confirm that above Name*Designation*Date* PhoneThis field is for validation purposes and should be left unchanged.
