APPLICATION FOR MEMBERSHIP PERSONAL INFORMATIONAll fields required.Title *Names in Full *Surname *Identification Number *Please enter a valid 13-digits South African ID number0 / 13Email *Please upload ID DocumentDrag and Drop (or) Choose FilesPlease upload Proof of ResidenceDrag and Drop (or) Choose FilesMobile *Alternative PhoneStreet Address *PO BoxSuburb *SuburbCity *CityProvince *ProvincePostal Code *Postal CodeDo you own fixed property? *Please selectYesNoIf not, current living arrangements?Please selectRentLive with ParentsOtherYears at present address *Language *Please selectEnglishAfrikaansSelect LanguageRSA Resident *Please selectYesNoOtherMaritial Status *Please selectBy ante nuptial contractIn community of propertyWidow/WidowerUnmarriedDivorcedCustomary LawNumber of Dependents *Were you previously a member of Pretorium Trust?YesNoIf 'Yes' Membership NumberEMPLOYMENT DETAILSAll fields required.Type of Employment *Please selectPermanentSelf-EmploymentContractedCommission EarnerPensionerName of Employer *Years of Service *Occupation *Employer Physical Address *(Current Employer)Name of previous employer and years of serviceSPOUSE'S PERSONAL INFORMATIONRequired if married in community of propertySpouse's InitialsSpouse's Maiden SurnameIf applicableSpouse's Identification numberPlease insert a valid 13-digit South African ID number (If applicable)0 / 13Spouse's PhonePlease attach Spouse's ID documentDrag and Drop (or) Choose FilesIf applicableSpouse's Employment DetailsType of EmploymentPlease selectPermanentSelf-EmploymentContractedCommission EarnerPensionerName of EmployerOccupationEmployment DateEmployer Physical Address(Current Employer)FRIEND OR RELATIVE INFORMATION(not living with you)First and Last Name *Relationship *Mobile *Home PhoneResidential AddressAUTHORISED CARD HOLDERSMEMBER - Title and InitialsSurnameID NumberPlease insert a valid 13-digit South African ID number0 / 13Card LimitZARSPOUSE - Title and InitialsSurnameID Number0 / 13Card LimitZARCHILD - Title and InitialsSurnameID Number0 / 13Card LimitZARTotal monthly purchase limit applied forZARDo you require a budget facility? *YesNoNO BUDGET PURCHASES ALLOWED ON LIQUOR, FOOD OR PETROL. No purchase of less than R300 will qualify for the budget facility. PURCHASES ON BUDGET QUALIFY FOR THE ANNUAL BONUSBudget limit applied for *ZARDate *Applicant's Signature *Start signing your signature hereYour browser does not support e-Signature field.I/We consent to the Credit Provider verifying my/our credit record/s with any credit reference agency or other Credit Providers and verify all information supplied on this application.Spouse SignatureStart signing your signature hereYour browser does not support e-Signature field.If applying for Pretorium Trust card.AFFORDABILITY ASSESSMENTAll fields required.Monthly IncomeGross Salary - ApplicantZARGross Salary - SpouseZAROther Income - ApplicantZAROther Income - SpouseZARPlease specifyPlease specifyTotal Income - ApplicantTotal Income - SpousePlease upload Proof of Income (Applicant)Drag and Drop (or) Choose FilesPlease attach 3 months latest payslips or bank statementsPlease upload Proof of Income (Spouse)Drag and Drop (or) Choose FilesPlease attach 3 months latest payslips or bank statementsPayslip DeductionsMedical Aid - ApplicantZARMedical Aid - SpouseZARPension / Provident Fund - ApplicantZARPension / Provident Fund - SpouseZARPAYE - ApplicantZARPAYE - SpouseZARUIF - ApplicantZARUIF - SpouseZAROther Deductions - ApplicantZAROther Deductions - SpouseZARTotal Deductions - ApplicantTotal Deductions - SpouseNet Salary - ApplicationNet Salary - SpouseMonthly ExpensesAccommodation Expense - ApplicantZARAccommodation Expense - SpouseZARTransport Expense - ApplicantZARTransport Expense - SpouseZARFood Expense - ApplicantZARFood Expense - SpouseZAREducation Expense - ApplicantZAREducation Expense - SpouseZARMedical Expense - ApplicantZARMedical Expense - SpouseZARMaintenance Expense - ApplicantZARMaintenance Expense - SpouseZARWater & Electricity - ApplicantZARWater & Electricity - SpouseZAROther Expenses - ApplicantZAROther Expense - SpouseZARTotal Expenses - ApplicantTotal Expenses - SpouseAccountsAsset Finance - ApplicantZARAsset Finance - SpouseZARPersonal Loans - ApplicantZARPersonal Loans - SpouseZARCredit Cards - ApplicantZARCredit Cards - SpouseZARBond Repayments - ApplicantZARBond Repayments - SpouseZARCellphone Expense - ApplicantZARCellphone Expense - SpouseZARMicro Loans - ApplicantZARMicro Loans - SpouseZARSecurity - ApplicantZARSecurity - SpouseZARInsurance - ApplicantZARInsurance - SpouseZARClothing - ApplicantZARClothing - SpouseZARGeneral Retail - ApplicantZARGeneral Retail - SpouseZARTotal Accounts - ApplicantTotal Accounts - SpouseMin Bond Repayment - ApplicantZARMin Bond Repayment - SpouseZARDisposable IncomePretorium Trust CardDisposable Income Total - ApplicantDisposable Income Total - SpouseSTATEMENT OF ASSETSFixed PropertySuburbMarket ValueZARCurrent BalanceZARSuburbMarket ValueZARCurrent BalanceZARSuburbMarket ValueZARCurrent BalanceZARMovable AssetsDescriptionMarket ValueZARDescriptionMarket ValueZARDescriptionMarket ValueZARCREDIT AND PAYMENT HISTORYUnder Administration or Debt Review? *YesNoIn the past 3 months, have you applied for debt review or debt counseling or are presently under administration or debt reviewAny disputes in process with a Credit Bureau? *YesNoLost Card Protection (optional) *Yes (R12)NoThe member confirms that he is aware of the Card Protection Fund offered by Pretorium Trust and that he must apply in writing for protection under the scheme. In terms of Pretorium Trust's Protection Fund Scheme, the member accepts liability for all payments made by Pretorium Trust or which Pretorium Trust is bound to make in respect of, or arising from, any use of the card before Pretorium Trust is reasonably able to act after receipt of the written notification by the member that the card is lost or stolen. Please debit my Pretorium Trust account annually with (R12 per card) in respect of the purchase cards issued on my membership number and include my name on the list of members of the Purchase Card Safeguarding Fund.Advance Payment Fund *AgreeThe member must contribute to the Advance Payment Fund at a minimum of R25 per month to a maximum of twice the monthly purchase limit. Please debit my account monthly with R25.Other Contribution ValueSignature *Start signing your signature hereYour browser does not support e-Signature field.Signature Spouse *Start signing your signature hereYour browser does not support e-Signature field.CONSENT AND SUBMISSIONDo you wish to receive your statement via: *EmailPostWould you like to be considered for an automatic annual credit limit increase? *YesNoDo you choose to be excluded from telemarketing campaigns by or on behalf of the Credit Provider? *YesNoWould you like to be considered for any mass distributions of e-mails or sms messages conducted by the Credit Provider? *YesNoPromotions by the Credit Provider on behalf of our suppliersWhere did you hear about us?Please selectMemberOnlineSocial MediaRadioPrinted MediaOtherIf referred, Member number?Preferred Payment Method?Please selectDebit OrderOtherDebit Order Instruction(If applicable)Account Holder NameAccount NumberAccount TypeBank NameBranch NumberDate of Debit OrderLast working dayFirst working dayPlease upload Account ConfirmationDrag and Drop (or) Choose FilesSigned at *Date *Date application completedSignature of Account Holder *Start signing your signature hereYour browser does not support e-Signature field.Debit Order approval.Cost of Credit *I agree with the membership fees as per the Cost of CreditTerms and Conditions *Yes, I agree with the privacy policy and terms and conditions. Â Applicant's Signature *Start signing your signature hereYour browser does not support e-Signature field.Spouse SignatureStart signing your signature hereYour browser does not support e-Signature field.If applicableSubmitSave as Draft (THIS DOES NOT SUBMIT THE FORM)
