APPLICATION FOR INSTALMENT FINANCE INDIVIDUAL
NEW
GOODS DESCRIPTION MODEL MAKE M&M CODE
USED
DEALER/BRANCH TEL NO.
CONTACT PERSON SALES PERSON FAX NO.
CASH PRICE (VAT INCL.) R VATABLE EXTRAS (VAT INCL.) INSTALMENT LEASE RENTAL
ADD COVER R RADIO /CD R TERM
LICENCE/REG FEE R NUMBER PLATES R RATE
CREDIT LIFE R WARRANTY R INITIATION FEE INCLUDE EXCLUDE
DEPOSIT/TRADE IN R OTHER R BALLOON / RESIDUAL R
FINANCE AMOUNT R OTHER R INSTALMENT R
PERSONAL DETAILS TITLE SURNAME ID NO.
FULL NAMES INITIALS DEPENDANTS
MALE FEMALE MARRIED OCOP COP SINGLE WIDOWED DATE MARRIED
HOME ADDRESS PERIOD
TEL(H) TEL(W) CELL FAX EMAIL
POSTAL ADDRESS CODE
PREVIOUS ADDRESS PERIOD
SPOUSE NAMES SPOUSE ID
NEXT OF KIN RELATIONSHIP
ADDRESS TEL
BOND DETAILS
BOND HOLDER AMOUNT OUTSTANDING
PROPERTY VALUE R INSTALMENT R /M PURCHASE PRICE R
DATE PURCHASED REGISTERED OWN NAME SPOUSE
RENTING
R
EMPLOYER DETAILS
EMPLOYER OCCUPATION
EMPLOYER ADDRESS TEL NO. OF YEARS
SALARY DATE PREVIOUS EMPLOYER NO. OF YEARS
SPOUSE EMPLOYER NO. OF YEARS
TEL OCCUPATION
BANK DETAILS BANK NAME BRANCH NAME BRANCH CODE
NAME OF ACCOUNT HOLDER ACCOUNT NO.
CREDIT CARD SAVINGS TRANSMISSION CURRENT
NEDBANK CLIENT
BRANCH ACCOUNT NO. INSTALMENTS PAID UP/CURRENT/TO BE SETTLED
TRADE REFERENCE
BRANCH ACCOUNT NO. INSTALMENTS PAID UP/CURRENT/TO BE SETTLED
ETHNIC GROUP
AFRICAN COLOURED INDIAN WHITE
LANGUAGE PREFERENCE
ENGLISH (PRIMARY) AFRIKAANS OTHER:
MFC/Individual App Form/2013/03
Signature Date
MFC, a division of Nedbank Limited Reg No 1951/000009/06, Vat Reg No 4320116074, 135 Rivonia Road, Sandton, 2196, South Africa. We subscribe to the Code of Banking Practice of The Banking Association South Africa and, for
unresolved disputes, support resolution through the Ombudsman for Banking Services. We are an authorised financial services provider. We are a registered credit provider in terms of the National Credit Act (NCR Reg No NCRCP16).
Page 1 of 2 APPLICATION FOR INSTALMENT FINANCE INDIVIDUAL
APPLICATION FOR INSTALMENT FINANCE INDIVIDUAL
APPLICANT INITIALS SURNAME
ID NO.
PERSONAL APPLICATION FORM
SALARY DETAILS OWN SPOUSE
BASIC MONTHLY (EXCL CAR ALLOWANCE) R R
CAR ALLOWANCE R R
TOTAL SALARY (BASIC & CAR ALLOWANCE) R R
MONTHLY COMMISSION R R
NET TAKE HOME PAY R R
INCOME OTHER THAN SALARY/WAGES** R R
SOURCE OF OTHER INCOME**
TOTAL MONTHLY HOUSEHOLD INCOME (NET SALARY & OTHER) R
HOUSEHOLD EXPENSES PER MONTH
BOND PAYMENT / RENT R RATES, WATER AND ELECTRICITY R
VEHICLE INSTALMENTS (EXCLUDING THOSE TO BE SETTLED) R PERSONAL LOAN REPAYMENTS R
CREDIT CARD REPAYMENTS R FURNITURE ACCOUNTS R
CLOTHING ACCOUNTS R OVERDRAFT REPAYMENTS R
POLICY / INSURANCE REPAYMENTS R TELEPHONE PAYMENT R
TRANSPORT COSTS R FOOD AND ENTERTAINMENT R
EDUCATION COSTS R MAINTENANCE R
HOUSEHOLD EXPENSES R OTHER R
TOTAL MONTHLY HOUSEHOLD EXPENSES R
HOUSEHOLD SURPLUS/DISPOSABLE INCOME R
ARE YOU CURRENTLY LIABLE AS SURETY GUARANTOR CO-DEBTOR
SPECIFY DETAILS
IF YOU HAVE SIGNED SURETY OR CO-DEBTOR PLEASE INDICATE THE FULL AMOUNT OUTSTANDING
PLEASE TICK YOUR PREFERRED METHOD OF COMMUNICATION ALL EMAIL POST TELEPHONE SMS
DECLARATION BY CLIENT
1. I confirm that:
A.
I am not a minor.
B . I have never been declared mentally unfit by a 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 re-arrangement in existence.
F. I have not previously applied for a debt re-arrangement.
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.
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 to
process the credit application and/or application for insurance, and to share my payment behavior with any credit agency.
Y N
3. I hereby declare that all of the above information is true and correct.
MFC/Individual App Form/2013/03
Signature Date
MFC, a division of Nedbank Limited Reg No 1951/000009/06, Vat Reg No 4320116074, 135 Rivonia Road, Sandton, 2196, South Africa. We subscribe to the Code of Banking Practice of The Banking Association South Africa and, for
unresolved disputes, support resolution through the Ombudsman for Banking Services. We are an authorised financial services provider. We are a registered credit provider in terms of the National Credit Act (NCR Reg No NCRCP16).
Page 2 of 2 APPLICATION FOR INSTALMENT FINANCE INDIVIDUAL
