Model:

Make:

Telephone No.:

Cash Price (VAT incl.): R

Deposit: R

Employer Details

Employer:

Occupation:

Employer Address:

No. of Years:

Telephone:

Salary Details:

Basic Monthly (excl car allowance): R

Net Take Home Pay: R

Income Other Than Salary/Wages: R

Household Expenses per Month

Bond payment/rent: R

Vehicle Installment (excluding those to be settled): R

Credit Card Repayment: R

Clothing Accounts: R

Policy/Insurance Repayments: R

Transport Costs: R

Education Costs: R

Household Expenses: R

Total Monthly Household Expenses: R

Household Surplus/Disposable Income: R

Rates, Water and Electricity: R

Personal Loan Repayments: R

Furniture Accounts: R

Overdraft Repayments: R

Telephone Repayments: R

Food and Entertainment: R

Maintenance: R

Other: R

Are you currently liable as: SuretyGuarantorCo-Debtor

Specify Details:

If you have signed surety of co-debtor please indicate the full amount outstanding:

Bank Details

Bank Name:

Account No.:

SavingsTransmissionCurrent

Personal Details:

Title:

Surname:

ID No.:

Full Names:

Initials:

maleFemale

MarriedOCOPCOPSingleWidowed

Telephone (Work):

Cell:

Email: