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Company Details

Type of Entity*

No. of trustees

Any trustee a juristic person?

Yes
No

Co/CC/Trust Reg. No.

Co/CC/Trust Name (Reg. Name)

% Black Owned

Trading Name

Tax No.

VAT No.

Holding Company Reg. No.

Holding Company Name

Address

Street Address City Province ZIP / Postal Code

Period at Address

Postal Address*

Street Address City Province ZIP / Postal Code

*if different from residential

Owner of the property?

Landlord's Details

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Banking Details

Banker'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 institutions

Name #1

Account No. #1

Instalment Amount #1

Balance Owing #1

Name #2

Account No. #2

Instalment Amount #3

Balance Owing #2

Name #3

Account No. #3

Instalment Amount #3

Balance Owing #3

Description of other property registered in company name

Stand No.

Suburb

Bonded?

Bondholder Name

Bondholder Address

Street Address City State / Province / Region ZIP / Postal Code Country

Purchase Price

Present Value

Date of Purchase

Outstanding Value - Bond

Financial Details

Selling Price (VAT Incl.)

Extras Description #1

Extras Description Value #1

Extras Description #2

Extras Description Value #2

Extras Description #3

Extras Description Value #3

Extras Description #4

Extras Description Value #4

Total of Extras

Subtotal

Insurance Value #1

Insurance Value #2

Insurance Value #3

Less Deposit/Initial Rental

Principal Debt

Trade Price

Retail Price

Residual/Balloon Value

Initiation/Processing Fees to be financed?

Dealer's Information

Dealer Code

Original Branch

Input Branch

Cr.Prov.Intr Brn

Marketer's Code

Name

Marketer's ID No.

Fax No.

Lead Provider

ID No.

Buy Line

Account No.

SIC

Language of Choice

Business Details

Registered 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 resolution

Name #1

ID No. #1

Designation #1

Name #2

ID No. #3

Designation #2

Name #3

ID No. #3

Designation #3

Name #4

ID No. #4

Designation #4

Name #5

ID No. #5

Designation #5

Full Names & ID No. of all Directors/Members/Partners/Trustees

Yes/No - Prepared to guarentee facility/deal?

Name #1

ID No. #1

Guarantee Deal? #1

Yes
No

%Share #1

Name #2

ID No. #2

Guarantee Deal? #2

Yes
No

%Share #2

Name #3

ID No. #3

Guarantee Deal? #3

Yes
No

%Share #3

Name #4

ID No. #4

Guarantee Deal? #4

Yes
No

%Share #4

Name #5

ID No. #5

Guarantee Deal? #5

Yes
No

%Share #5

Name #6

ID No. #6

Guarantee Deal? #6

Yes
No

%Share #6

Name #7

ID No. #7

Guarantee Deal? #7

Yes
No

%Share #7

Name #8

ID No. #8

Guarantee Deal? #8

Yes
No

%Share #8

Name #9

ID No. #9

Guarantee Deal? #9

Yes
No

%Share #9

Name #10

ID No. #10

Guarantee Deal? #10

Yes
No

%Share #10

Foreign Controlled?

Percentage?

Contact Person

Designation

Transaction Type

Transaction Type*

Instalment Sale
Lease
Rental
Term Loan

Period*

NACM Rate % (what we are going to use)*

Do you require a fuel and maintenance facility?*

Yes
No

Transaction Details

Supplier/Dealer Name

Dealer Tel. No

Contact Name

Tel. No.

Goods Description

Insurance Company/Broker

Policy No.

Renewal Date

Confirmed By

Tel. No.

Declaration

I/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*

Email

This field is for validation purposes and should be left unchanged.

Vehicle Details

Personal Details

Spouse Details

Next of Kin (NOT residing with you)

Employment Details

Banking Details - Applicant

Home Ownership

Vehicle Finance History

Comprehensive Insurance

Income

Expenses

Liability Details

Credit Check Consent Details

Comprehensive Insurance

Required Documents

Declaration

Company Details

Banking Details

Previous or current amounts owing to financial institutions

Description of other property registered in company name

Financial Details

Dealer's Information

Business Details

Authorised signatories as per resolution

Full Names & ID No. of all Directors/Members/Partners/Trustees

Transaction Type

Transaction Details

Insurance Company/Broker

Declaration