Application for Installment Finance
 

Please complete.

 
  Goods Description
     
 
   
 
     
  Model:
  Make:
     
  Personal Details:
     
  Title:
  Surname and Full Names:
  ID Number:
  Initials:
  Dependants:
  Date Married:
  Tel (H):
  Tel (W):
  Cell:
  Fax:
  Email:
  Home Address:
  Period at this Address:
  Postal Address:
  Previous Address:
  Period at Previous Address:
  Spouse Names:
  Spouse ID:
  Next of Kin:
  Relationship:
  Address:
  Tel:
 
     
  Marriage Status:
     
 
   
  Bond Details:
     
  Bond Holder:
  Amount Outstanding:
  Property Value (R):
  Installment per month:
  Purchase Price:
  Date Purchased:
  Renting (R):
     
  Registered:
     
 
   
  Employer Details:
     
  Employer:
  Occupation:
  Employer Address:
  Tel:
  No. of Years:
  Salary Date:
  Previous Employer:
  No. of Years:
  Spouse Employer:
  No. of Years:
  Tel:
  Occupation:
     
  Salary Details:
     
  Basic Own:
  Basic Spouse:
  Other:
     
  Bank Details:
     
  Bank Name:
  Branch Name:
  Branch Code:
  Name of Account Holder:
  Account No:
     
 
     
 
   
  Trade Reference 1:
     
  Company:
  Branch:
  Account No:
  Instalments:
     
 
     
 
   
  Trade Reference 2:
     
  Company:
  Branch:
  Account No:
  Instalments:
     
 
     
 
   
  Ethnic Group
     
 
   
  Language Preference
     
 
   
  The information that you have supplied regarding your personal and financial matters will be treated as confidential. We require your consent to utilise this information for the application of vehicle finance and for products that will be made available to you during this transaction or future transactions. I hereby consent to information supplied by me to be made available to credit bureaus. I hereby consent to Venter Motors collecting data from credit bureaus to verify the information given by me on this application form.
     
  I agree:
  Date:
     
  Household Income Details:
     
  Gross Remuneration:
  Car Allowance included in Gross:
  Monthly Commission:
  Other Income other than Salary / Wages:
  Source of other income:
  Total Monthly Household Income:
     
  Household Expenses per Month:
     
  Bond Payment / Rent:
  Vehicle instalments (Excluding those to be settled):
  Credit Card Repayments:
  Clothing Accounts:
  Policy / Insurance Repayments:
  Transport Costs:
  Educational Costs:
  Household Expenses:
  Rates, Water and Electricity:
  Personal Loan Repayments:
  Furniture Accounts:
  Overdraft Repayments:
  Telephone Payment:
  Food and Entertainment:
  Maintenance:
  Other:
     
 
     
  Total Monthly Household Expenses:
  Household Surplus / Disposable Income:
     
  Are your currently liable as:
     
  Surety
  Guarantor
  Co-Debtor
     
  Specify Details:
     
  Specify Details:
  If you have signed surety or Co-Debtor please indicate the full amount outstanding:
     
  I confirm that:
     
  I am not a minor.
  I have never been declared mentally unfit by a court.
  I am not subject to an administration order.
  I do not have any current application pending or debt restructuring of alleviation.
  I do not have any current debt re-arrangement in existence.
  I have not previously applied for debt re-arrangement.
  I am not under sequestration.
  I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.
     
  If any of the above is incorrect give details:
 
   
   
  Declaration by client:
   
  I hereby grant the Credit Provider the right to communicate with me through any electronic/written media or verbally in order to make available to me, their product offering and to utilise my information for supporting products as communicated by one of the Credit Provider's Partners
     
 
   
  I hereby grand the Credit Provider the right to increase my Credit Limit once every year to accommodaty any Value Added Products needed and requested by me.
     
 
   
  I authorise the Credit Provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process this application:
     
 
   
  I also authorise the Credit Provider to share my payment behaviour with any credit agency.
     
 
   
   
  By electronically submitting this form I agree that all the information is correct and that it has been completed by the Applicant.
   
 


 
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