LENINGSAANSOEK PERSONAL INFORMATIONAll fields required.Member Number *Your Member Number0 / 13Title *Names in Full *Surname *Identification Number *Please enter a valid 13-digits South African ID number0 / 13Email *Please upload ID Document *Drag and Drop (or) Choose FilesPlease upload Proof of Residence *Drag 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 *EMPLOYMENT DETAILSAll fields required.Type of Employment *Please selectPermanentSelf-EmploymentContractedCommission EarnerPensionerName of Employer *Work PhoneYears of Service *Occupation *Employer Physical Address *(Current Employer)SPOUSE'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 applicableAFFORDABILITY ASSESSMENTAll fields required.Monthly IncomeGross Salary - Applicant *ZARGross Salary - SpouseZAROther Income - Applicant *ZAROther 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 - Applicant *ZARAccommodation 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 IncomeDisposable Income Total - ApplicantDisposable Income Total - SpouseSTATEMENT OF ASSETSFixed PropertySuburbMarket ValueZARCurrent BalanceZARSuburbMarket ValueZARCurrent BalanceZARSuburbMarket ValueZARCurrent BalanceZARMovable AssetsDescriptionMarket ValueZARDescriptionMarket ValueZARDescriptionMarket ValueZARCONSENT AND SUBMISSIONBank DetailsFor direct electronic transfers to your bank accountAccount Holder NameAccount NumberAccount TypeBank NameBranch NumberPlease upload Account Confirmation *Drag and Drop (or) Choose FilesLoan RequiredThe applicable interest rate will be fixedLoan Amount RequiredMaximum repayment periodThe cost of credit (Interest Rate) per annum is as follows: 6 - 24 months: Fixed at the prime lending rate plus 3% 24 - 36 months: Fixed at the prime lending rate plus 4% Signed 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. Confirmation of Application *I/we hereby confirm that I/we have answered all your questions and relevant information fully and truthfully as part of this assessment process. I/we hereby confirm that I/we have fully disclosed my/our debt repayment historyApplicant'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)
