Application for Finance: Individual
New
Goods description Model Make M&M code
Used
Dealer/Branch Tel
Contact person Sales Person Fax
Cash price (VAT incl) R Vatable extras (VAT incl) Instalment Lease
Adcover R Audio/media R Term
Licence/Registration R Warranty R Rate
Credit life R Other R Initiation fee Include Exclude
Deposit/Trade-in R Balloon
Financeable amount R Instalment
Personal detailsal details
Client type SA citizen residing in SA Foreign national residing in SA Asylum seeker Refugee SA citizen residing abroad
Title Surname Identity number
Full names Initials
Place of birth Country Nationality Country Male Female
Marital status OCOP COP Single Widowed Divorced Customary law/Tribal
Married under foreign law Date married
Home address Period
Country of residence Country Residential address/Geographic location Country
Tel (H) Tel (W) Cell Fax
Postal address Email
Postcode
Spouse name Spouse identity number
Next of kin Relationship
Address Tel
Are you a registered VAT vendor? Yes No VAT reg no
For what purpose will the goods be used? Taxable Non-taxable
Do you have a foreign birthplace, nationality, citizenship or tax obligations? Yes No
Ethnic group African Coloured Indian White
Language preference English (Primary) Afrikaans Other
Bond details
Bondholder
Registered Own name Spouse Renting R
Employer details
Employer Occupation
Industry type
Employer address No of years
Salary date Previous employer No of years
Spouse employer No of years
Tel Occupation
Banking details
Bank name Branch name Branch code
Name of accountholder Account no
Type of account Savings Current
Source of income Salary earner Self-employed Commission Director
Pensioner Maintenance Court order Member of a close corporation
Nedbank client Branch Account no Instalments Paid up/Current/To be settled
Applicant signature: ................................................................................................................................................................................. Date: ...................................................................................................
MFC, a division of Nedbank Limited Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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Trade reference Branch Account no Instalments Paid up / Current / To be settled
Income and expenses
Applicant income details Spouse/Partner income details
Basic salary R Basic salary R
Car allowance R Car allowance R
Commission R Commission R
Overtime R Overtime R
Other R Other R
Source of other income Other household income R
Total salary R Total salary R
Net salary R Net salary R
Total monthly income R
Expense details
Bond payment R Rates, water and electricity R
Vehicle instalments (excl those to be settled) R Personal loan repayments R
Credit card payments R Furniture accounts R
Clothing accounts R Overdraft payments R
Policy/Insurance repayments R Telephone payments R
Transport costs R Food and entertainment R
Education costs R Education costs R
Property rent R Other R
Total monthly applicant/household surplus /
Total monthly applicant/household expenses R R
disposal income
Are you currently liable as Surety Guarantor Codebtor
Specify details
If you have signed surety or are a codebtor please indicate full amount outstanding R
Please tick your preferred method of communication All Email Post Telephone SMS
I hereby provide my/our express consent to the credit provider to request bank statements of the bank account(s) listed below, for the sole purpose of applying for vehicle finance. Yes No
Electronic bank statement banking details
Bank name Branch name
Name of accountholder Branch code
Account no Account type
Declaration by applicant
1. I confirm that:
a. I am not a minor.
b. I have never been declared mentally unfit by a South African court.
c. I am not subject to an administration order.
d. I do not have any current application pending for debt restructuring or alleviation.
e. I do not have any current debt rearrangement in place.
f. I have not previously applied for debt rearrangement.
g. I am not under sequestration.
h. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act, 2005.
i. If any of the above is incorrect, state which and give details.
2. I hereby give consent to the credit provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require Yes No
to process the credit application and to share my payment behaviour with any credit agency.
3. I hereby declare that all of the above information is true and correct.
Signed at .................................................................................................................................................................................................................... on .............................. /.............................. /.............................. /
Place Day Month Year
Witness
......................................................................................................................... .........................................................................................................................
Witness signature Applicant signature
MFC, a division of Nedbank Limited Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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