Application for Finance 

Company Details
Physical Address *
Physical Address
Tel Number *
Tel Number
Fax Number *
Fax Number
Contact Person *
Contact Person
Mobile Number *
Mobile Number
About Finance
Facility Required *
R
R
Directors/Sureties
Name *
Name
Physical Address *
Physical Address
Mobile Number *
Mobile Number
Home Number *
Home Number
Marital Status *
Name
Name
Physical Address
Physical Address
Mobile Number
Mobile Number
Home Number
Home Number
Marital Status
Single Married (ICP) Married (ANC with Accrual) Other
Landlord Details
Physical Address *
Physical Address
Tel Number *
Tel Number
Banking Details
Next of Kin
Name *
Name
Physical Address *
Physical Address
Contact Number *
Contact Number
Terms and Conditions
I, CONTACT NAME ABOVE for and on behalf of COMPANY NAME ABOVE hereby apply for finance facilities, and I declare and warrant as a condition for any contract to be signed that the information given on this application is true and correct in every respect. In the event of any of my/our warranties, undertakings or representations being false, the Credit Grantor/Broker of Assigns shall have the right to declare the transaction void of no force or effect and set it aside, accordingly. I acknowledge that if the transaction is thus declared void, I shall be liable for any loss or damage which the Credit Grantor/Broker or Assigns shall suffer as a result, and that any monies paid by me may be appropriated against such loss. The Credit Grant/Broker or Assigns is hereby indemnified against any misrepresentation, wilful omissions, or any loss incurred by any Parties as a result thereof. I authorise you to make any enquiries you deem necessary relating to this application, and the above-mentioned persons are authorised to disclose information in support of this application. I also agree to pay any costs incurred by the Credit Grantor/Broker or Assigns in processing this application whether successful or not i.e. valuation fees in respect of property/machinery/vehicles. I/We consent to the Credit Grantor/Broker of Assigns making enquiries about my/our credit record with any credit reference agency and any other party to confirm the details on this application. The Credit Grantor/Broker of Assigns may also provide credit reference agencies with regular updates regarding how I/we manage my/our account, including my/our failure to meet agreed terms and conditions. I/We also consent that credit reference agencies may, in turn, make the records and details available to other credit grantors as and when requested. The Credit Grantor/Broker or Assigns or its sessionally may also give this information to any person who, in its opinion, needs it to carry out any of the Credit Grantor/Broker or Assigns rights or duties in terms of the contract or any law pertaining to the products I/we have requested. The information set out in this credit application will be valid for a period of 12 months. Any new or additional credit application after the 12 months will be done on the self-same basis as set out above. The Credit Grantor, Broker or Assigns will be entitled to seek and/or request the above mentioned information should it deem necessary, without further permission being expressly provided by the Credit Receiver.

Personal Statement of Assets and Liabilities

Assets
Full Name *
Full Name
Date *
Date
R
R
R
R
R
R
R
(Furniture, jewellery, etc.)
R
R
R
R
R
LIABILITIES
R
R
R
R
R
R
R
Specify
R
R
R
I declare that the information furnished herein is true and correct and that I do not know of any fact which if disclosed might affect your decision in regard to the proposed application. *