{"id":100689,"date":"2025-10-27T07:48:02","date_gmt":"2025-10-27T05:48:02","guid":{"rendered":"https:\/\/www.bonuscard.co.za\/korporatiewe-lidmaatskap\/"},"modified":"2026-05-05T12:57:31","modified_gmt":"2026-05-05T10:57:31","slug":"korporatiewe-lidmaatskap","status":"publish","type":"page","link":"https:\/\/www.bonuscard.co.za\/af-za\/korporatiewe-lidmaatskap\/","title":{"rendered":"Korporatiewe Lidmaatskap"},"content":{"rendered":"\n<div class=\"et_pb_section_0 et_pb_section et_pb_fullwidth_section et_section_regular et_block_section\"><div class=\"et_pb_fullwidth_image_0 et_pb_fullwidth_image et_pb_module\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2025\/09\/cardstrip-bg.jpg\" width=\"1920\" height=\"225\" srcset=\"https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2025\/09\/cardstrip-bg.jpg 1920w, https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2025\/09\/cardstrip-bg-1280x150.jpg 1280w, https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2025\/09\/cardstrip-bg-980x115.jpg 980w, https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2025\/09\/cardstrip-bg-480x56.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) and (max-width: 1280px) 1280px, (min-width: 1281px) 1920px, 100vw\" class=\"wp-image-100385\" title=\"cardstrip-bg\" \/><\/div><\/div><div class=\"et_pb_section_1 et_pb_section et_section_regular et_block_section\"><div class=\"et_pb_row_0 et_pb_row et_block_row\"><div class=\"et_pb_column_0 et_pb_column et_pb_column_4_4 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_heading_0 et_pb_heading et_pb_module et_block_module\"><div class=\"et_pb_heading_container\"><h1 class=\"et_pb_module_header\">KORPORATIEWE AANSOEKVORM<\/h1><\/div><\/div><\/div><\/div><div class=\"et_pb_row_1 et_pb_row et_block_row\"><div class=\"et_pb_column_1 et_pb_column et_pb_column_4_4 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_code_0 et_pb_code et_pb_module\"><div class=\"et_pb_code_inner\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-100425 forminator-design--material forminator-custom forminator_ajax draft-enabled\" data-forminator-render=\"0\" data-form=\"forminator-module-100425\" data-uid=\"6a0086b0b311a\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-100425\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-100425 forminator-design--material forminator-custom forminator_ajax draft-enabled\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"100425\"\r\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"default\" data-design=\"material\" data-grid=\"custom\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"6a0086b0b311a\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-pagination-progress\" aria-hidden=\"true\"><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-0\"\r\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-0-label\"\r\n\t\t\t\tdata-step=\"0\"\r\n\t\t\t\tdata-label=\"Finish\"\r\n\t\t\t\tdata-actual-label=\"15%\"\r\n\t\t\t\tdata-name=\"page-break-1\"\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">BUSINESS INFORMATION<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #005775;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-6\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_6a0086b0b311a\" id=\"forminator-field-name-6_6a0086b0b311a-label\" class=\"forminator-label\">Name of Business <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"\" id=\"forminator-field-name-6_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-7\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-7_6a0086b0b311a\" id=\"forminator-field-name-7_6a0086b0b311a-label\" class=\"forminator-label\">Trading Name<\/label><input type=\"text\" name=\"name-7\" value=\"\" placeholder=\"\" id=\"forminator-field-name-7_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-19\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-19_6a0086b0b311a\" id=\"forminator-field-name-19_6a0086b0b311a-label\" class=\"forminator-label\">Registration Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-19\" value=\"\" placeholder=\"E.g. 2004\/130312\/07\" id=\"forminator-field-name-19_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a0086b0b311a\" id=\"forminator-field-email-2_6a0086b0b311a-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-2_6a0086b0b311a\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-8\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-8_6a0086b0b311a\" id=\"forminator-field-phone-8_6a0086b0b311a-label\" class=\"forminator-label\">Business Phone<\/label><input type=\"text\" name=\"phone-8\" value=\"\" placeholder=\"E.g. 012 362 1234\" id=\"forminator-field-phone-8_6a0086b0b311a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-9\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-9_6a0086b0b311a\" id=\"forminator-field-phone-9_6a0086b0b311a-label\" class=\"forminator-label\">Business Mobile <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-9\" value=\"\" placeholder=\"E.g. 082 323 1234\" id=\"forminator-field-phone-9_6a0086b0b311a\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"za\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_6a0086b0b311a\" id=\"forminator-field-textarea-8_6a0086b0b311a-label\" class=\"forminator-label\">Business Physical Address <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_6a0086b0b311a\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" aria-describedby=\"forminator-field-textarea-8_6a0086b0b311a-description\" ><\/textarea><span id=\"forminator-field-textarea-8_6a0086b0b311a-description\" class=\"forminator-description\">Business Address<\/span><\/div><\/div><div id=\"textarea-10\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-10_6a0086b0b311a\" id=\"forminator-field-textarea-10_6a0086b0b311a-label\" class=\"forminator-label\">Business Postal Address<\/label><textarea name=\"textarea-10\" placeholder=\"\" id=\"forminator-field-textarea-10_6a0086b0b311a\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" aria-describedby=\"forminator-field-textarea-10_6a0086b0b311a-description\" ><\/textarea><span id=\"forminator-field-textarea-10_6a0086b0b311a-description\" class=\"forminator-description\">Business Postal Address<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-9\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-9_6a0086b0b311a\" id=\"forminator-field-upload-9_6a0086b0b311a-label\" class=\"forminator-label\">Upload Proof of Physical Address<\/label><div class=\"forminator-file-upload \" data-element=\"upload-9_6a0086b0b311a\"><input type=\"file\" name=\"upload-9\" id=\"forminator-field-upload-9_6a0086b0b311a\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.json\" tabindex=\"-1\"><button id=\"forminator-field-upload-9_6a0086b0b311a_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-9_6a0086b0b311a\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><div id=\"select-14\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-100425__field--select-14_6a0086b0b311a\" id=\"forminator-form-100425__field--select-14_6a0086b0b311a-label\" class=\"forminator-label\">Language<\/label><select  id=\"forminator-form-100425__field--select-14_6a0086b0b311a\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-14\" data-default-value=\"\" data-placeholder=\"Please select\" data-search=\"false\" data-search-placeholder=\"Please select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-100425__field--select-14_6a0086b0b311a-label\" aria-describedby=\"forminator-form-100425__field--select-14_6a0086b0b311a-description\"><option value=\"\"  >Please select<\/option><option value=\"English\"  data-calculation=\"0\">English<\/option><option value=\"Afrikaans\"  data-calculation=\"0\">Afrikaans<\/option><\/select><span id=\"forminator-form-100425__field--select-14_6a0086b0b311a-description\" class=\"forminator-description\">Select Language<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-10\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-100425__field--select-10_6a0086b0b311a\" id=\"forminator-form-100425__field--select-10_6a0086b0b311a-label\" class=\"forminator-label\">Do you own fixed property? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-100425__field--select-10_6a0086b0b311a\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-10\" data-default-value=\"\" data-placeholder=\"Please select\" data-search=\"false\" data-search-placeholder=\"Please select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-100425__field--select-10_6a0086b0b311a-label\"><option value=\"\"  >Please select<\/option><option value=\"Yes\"  data-calculation=\"0\">Yes<\/option><option value=\"No\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><div id=\"select-15\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-100425__field--select-15_6a0086b0b311a\" id=\"forminator-form-100425__field--select-15_6a0086b0b311a-label\" class=\"forminator-label\">If not, do you:<\/label><div class=\"forminator-multiselect\" aria-labelledby=\"forminator-form-100425__field--select-15_6a0086b0b311a-label\"><label id=\"forminator-form-100425__field--select-15_6a0086b0b311a-1-label\" for=\"forminator-form-100425__field--select-15_6a0086b0b311a-1\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-15[]\" value=\"Rent\" id=\"forminator-form-100425__field--select-15_6a0086b0b311a-1\" aria-labelledby=\"forminator-form-100425__field--select-15_6a0086b0b311a-1-label\" data-calculation=\"0\"   \/>Rent<\/label><label id=\"forminator-form-100425__field--select-15_6a0086b0b311a-2-label\" for=\"forminator-form-100425__field--select-15_6a0086b0b311a-2\" class=\"forminator-option\"><input type=\"checkbox\" name=\"select-15[]\" value=\"Other\" id=\"forminator-form-100425__field--select-15_6a0086b0b311a-2\" aria-labelledby=\"forminator-form-100425__field--select-15_6a0086b0b311a-2-label\" data-calculation=\"0\"   \/>Other<\/label><input type='hidden' name='select-15-multiselect-default-values' class='multiselect-default-values' value='' \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6a0086b0b311a-label\" class=\"forminator-label\">Were you previously a member of Pretorium Trust?<\/span><label id=\"forminator-field-checkbox-14-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-14-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Yes\" id=\"forminator-field-checkbox-14-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-14-1-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-14-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-14-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"No\" id=\"forminator-field-checkbox-14-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-14-2-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"name-16\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-16_6a0086b0b311a\" id=\"forminator-field-name-16_6a0086b0b311a-label\" class=\"forminator-label\">If 'Yes' Membership Number<\/label><input type=\"text\" name=\"name-16\" value=\"\" placeholder=\"\" id=\"forminator-field-name-16_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-1\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-1-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"1\"\r\n\t\t\t\tdata-label=\"15%\"\r\n\t\t\t\tdata-actual-label=\"Page 2\"\r\n\t\t\t\tdata-name=\"page-break-3\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">INFORMATION OF BUSINESS OWNER<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #005775;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a0086b0b311a\" id=\"forminator-field-name-3_6a0086b0b311a-label\" class=\"forminator-label\">Surname <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g. Doe\" id=\"forminator-field-name-3_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0086b0b311a\" id=\"forminator-field-name-1_6a0086b0b311a-label\" class=\"forminator-label\">Intials <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. J\" id=\"forminator-field-name-1_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0086b0b311a\" id=\"forminator-field-phone-1_6a0086b0b311a-label\" class=\"forminator-label\">Business Phone<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. 012 361 5526\" id=\"forminator-field-phone-1_6a0086b0b311a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6a0086b0b311a\" id=\"forminator-field-phone-3_6a0086b0b311a-label\" class=\"forminator-label\">Mobile <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"E.g. 082 123 4567\" id=\"forminator-field-phone-3_6a0086b0b311a\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-35\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-35_6a0086b0b311a\" id=\"forminator-field-text-35_6a0086b0b311a-label\" class=\"forminator-label\">Street Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-35\" value=\"\" placeholder=\"E.g. 40 Ingersol\" id=\"forminator-field-text-35_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-36\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-36_6a0086b0b311a\" id=\"forminator-field-text-36_6a0086b0b311a-label\" class=\"forminator-label\">Suburb <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-36\" value=\"\" placeholder=\"E.g. Lynnwood\" id=\"forminator-field-text-36_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-37\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-37_6a0086b0b311a\" id=\"forminator-field-text-37_6a0086b0b311a-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-37\" value=\"\" placeholder=\"E.g. Pretoria\" id=\"forminator-field-text-37_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-38\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-38_6a0086b0b311a\" id=\"forminator-field-text-38_6a0086b0b311a-label\" class=\"forminator-label\">Province <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-38\" value=\"\" placeholder=\"E.g. Gauteng\" id=\"forminator-field-text-38_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-39\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-39_6a0086b0b311a\" id=\"forminator-field-text-39_6a0086b0b311a-label\" class=\"forminator-label\">Postal Code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-39\" value=\"\" placeholder=\"E.g. 0020\" id=\"forminator-field-text-39_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-20\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">INFORMATION OF BUSINESS ASSOCIATE<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #005775;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-20\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-20_6a0086b0b311a\" id=\"forminator-field-name-20_6a0086b0b311a-label\" class=\"forminator-label\">Surname<\/label><input type=\"text\" name=\"name-20\" value=\"\" placeholder=\"E.g. Doe\" id=\"forminator-field-name-20_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-21\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-21_6a0086b0b311a\" id=\"forminator-field-name-21_6a0086b0b311a-label\" class=\"forminator-label\">Intials<\/label><input type=\"text\" name=\"name-21\" value=\"\" placeholder=\"E.g. J\" id=\"forminator-field-name-21_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-10\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-10_6a0086b0b311a\" id=\"forminator-field-phone-10_6a0086b0b311a-label\" class=\"forminator-label\">Business Phone<\/label><input type=\"text\" name=\"phone-10\" value=\"\" placeholder=\"E.g. 012 361 5526\" id=\"forminator-field-phone-10_6a0086b0b311a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-11\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-11_6a0086b0b311a\" id=\"forminator-field-phone-11_6a0086b0b311a-label\" class=\"forminator-label\">Mobile<\/label><input type=\"text\" name=\"phone-11\" value=\"\" placeholder=\"E.g. 082 123 4567\" id=\"forminator-field-phone-11_6a0086b0b311a\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"ZA\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-41\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-41_6a0086b0b311a\" id=\"forminator-field-text-41_6a0086b0b311a-label\" class=\"forminator-label\">Street Address<\/label><input type=\"text\" name=\"text-41\" value=\"\" placeholder=\"E.g. 40 Ingersol\" id=\"forminator-field-text-41_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-42\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-42_6a0086b0b311a\" id=\"forminator-field-text-42_6a0086b0b311a-label\" class=\"forminator-label\">Suburb<\/label><input type=\"text\" name=\"text-42\" value=\"\" placeholder=\"E.g. Lynnwood\" id=\"forminator-field-text-42_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-43\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-43_6a0086b0b311a\" id=\"forminator-field-text-43_6a0086b0b311a-label\" class=\"forminator-label\">City<\/label><input type=\"text\" name=\"text-43\" value=\"\" placeholder=\"E.g. Pretoria\" id=\"forminator-field-text-43_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-44\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-44_6a0086b0b311a\" id=\"forminator-field-text-44_6a0086b0b311a-label\" class=\"forminator-label\">Province<\/label><input type=\"text\" name=\"text-44\" value=\"\" placeholder=\"E.g. Gauteng\" id=\"forminator-field-text-44_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-45\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-45_6a0086b0b311a\" id=\"forminator-field-text-45_6a0086b0b311a-label\" class=\"forminator-label\">Postal Code<\/label><input type=\"text\" name=\"text-45\" value=\"\" placeholder=\"E.g. 0020\" id=\"forminator-field-text-45_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-2\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-2-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"2\"\r\n\t\t\t\tdata-label=\"Page  2\"\r\n\t\t\t\tdata-actual-label=\"Page 3\"\r\n\t\t\t\tdata-name=\"page-break-6\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">AUTHORISED CARD HOLDERS<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #065766;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-10\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-10_6a0086b0b311a\" id=\"forminator-field-name-10_6a0086b0b311a-label\" class=\"forminator-label\">Title and Initials <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-10\" value=\"\" placeholder=\"E.g. Mr J\" id=\"forminator-field-name-10_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-11\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-11_6a0086b0b311a\" id=\"forminator-field-name-11_6a0086b0b311a-label\" class=\"forminator-label\">Surname <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-11\" value=\"\" placeholder=\"E.g. Doe\" id=\"forminator-field-name-11_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a0086b0b311a\" id=\"forminator-field-text-3_6a0086b0b311a-label\" class=\"forminator-label\">ID Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"1\" maxlength=\"13\" aria-describedby=\"forminator-field-text-3_6a0086b0b311a-description\" \/><span id=\"forminator-field-text-3_6a0086b0b311a-description\" class=\"forminator-description\">Please insert a valid 13-digit South African ID number<span data-limit=\"13\" data-type=\"characters\">0 \/ 13<\/span><\/span><\/div><\/div><div id=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_6a0086b0b311a\" id=\"forminator-field-currency-1_6a0086b0b311a-label\" class=\"forminator-label\">Card Limit<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"\" placeholder=\"E.g. 5000\" id=\"forminator-field-currency-1_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-8\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a0086b0b527d\" id=\"forminator-field-ctlSignature6a0086b0b527d-label\" class=\"forminator-label\">Signature <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6a0086b0b527d_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a0086b0b527d_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a0086b0b527d\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-8\" value=\"6a0086b0b527d\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-12\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-12_6a0086b0b311a\" id=\"forminator-field-name-12_6a0086b0b311a-label\" class=\"forminator-label\">Title and Initials<\/label><input type=\"text\" name=\"name-12\" value=\"\" placeholder=\"\" id=\"forminator-field-name-12_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-13\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-13_6a0086b0b311a\" id=\"forminator-field-name-13_6a0086b0b311a-label\" class=\"forminator-label\">Surname<\/label><input type=\"text\" name=\"name-13\" value=\"\" placeholder=\"\" id=\"forminator-field-name-13_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a0086b0b311a\" id=\"forminator-field-text-4_6a0086b0b311a-label\" class=\"forminator-label\">ID Number<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"13\" \/><span id=\"forminator-field-text-4_6a0086b0b311a-description\" class=\"forminator-description\"><span data-limit=\"13\" data-type=\"characters\">0 \/ 13<\/span><\/span><\/div><\/div><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_6a0086b0b311a\" id=\"forminator-field-currency-2_6a0086b0b311a-label\" class=\"forminator-label\">Card Limit<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-2_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-9\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a0086b0b52fc\" id=\"forminator-field-ctlSignature6a0086b0b52fc-label\" class=\"forminator-label\">Signature<\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6a0086b0b52fc_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a0086b0b52fc_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a0086b0b52fc\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-9\" value=\"6a0086b0b52fc\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-14\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-14_6a0086b0b311a\" id=\"forminator-field-name-14_6a0086b0b311a-label\" class=\"forminator-label\">Title and Initials<\/label><input type=\"text\" name=\"name-14\" value=\"\" placeholder=\"\" id=\"forminator-field-name-14_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-15\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-15_6a0086b0b311a\" id=\"forminator-field-name-15_6a0086b0b311a-label\" class=\"forminator-label\">Surname<\/label><input type=\"text\" name=\"name-15\" value=\"\" placeholder=\"\" id=\"forminator-field-name-15_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a0086b0b311a\" id=\"forminator-field-text-5_6a0086b0b311a-label\" class=\"forminator-label\">ID Number<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"13\" \/><span id=\"forminator-field-text-5_6a0086b0b311a-description\" class=\"forminator-description\"><span data-limit=\"13\" data-type=\"characters\">0 \/ 13<\/span><\/span><\/div><\/div><div id=\"currency-3\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-3_6a0086b0b311a\" id=\"forminator-field-currency-3_6a0086b0b311a-label\" class=\"forminator-label\">Card Limit<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-3\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-3_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-11\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a0086b0b5363\" id=\"forminator-field-ctlSignature6a0086b0b5363-label\" class=\"forminator-label\">Signature<\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6a0086b0b5363_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a0086b0b5363_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a0086b0b5363\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-11\" value=\"6a0086b0b5363\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-22\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-22_6a0086b0b311a\" id=\"forminator-field-name-22_6a0086b0b311a-label\" class=\"forminator-label\">Title and Initials<\/label><input type=\"text\" name=\"name-22\" value=\"\" placeholder=\"\" id=\"forminator-field-name-22_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-23\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-23_6a0086b0b311a\" id=\"forminator-field-name-23_6a0086b0b311a-label\" class=\"forminator-label\">Surname<\/label><input type=\"text\" name=\"name-23\" value=\"\" placeholder=\"\" id=\"forminator-field-name-23_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-46\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-46_6a0086b0b311a\" id=\"forminator-field-text-46_6a0086b0b311a-label\" class=\"forminator-label\">ID Number<\/label><input type=\"text\" name=\"text-46\" value=\"\" placeholder=\"\" id=\"forminator-field-text-46_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"13\" \/><span id=\"forminator-field-text-46_6a0086b0b311a-description\" class=\"forminator-description\"><span data-limit=\"13\" data-type=\"characters\">0 \/ 13<\/span><\/span><\/div><\/div><div id=\"currency-71\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-71_6a0086b0b311a\" id=\"forminator-field-currency-71_6a0086b0b311a-label\" class=\"forminator-label\">Card Limit<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-71\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-71_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-10\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a0086b0b53c9\" id=\"forminator-field-ctlSignature6a0086b0b53c9-label\" class=\"forminator-label\">Signature<\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6a0086b0b53c9_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a0086b0b53c9_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a0086b0b53c9\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-10\" value=\"6a0086b0b53c9\" class=\"signature-prefix\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-4\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-4_6a0086b0b311a\" id=\"forminator-field-currency-4_6a0086b0b311a-label\" class=\"forminator-label\">Total monthly purchase limit applied for <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-4\" value=\"\" placeholder=\"E.g. 10000\" id=\"forminator-field-currency-4_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-61\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-61_6a0086b0b311a\" id=\"forminator-field-currency-61_6a0086b0b311a-label\" class=\"forminator-label\">Budget limit applied for <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-61\" value=\"\" placeholder=\"E.g. 5000\" id=\"forminator-field-currency-61_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6a0086b0b311a\" id=\"forminator-field-date-4-picker_6a0086b0b311a-label\" class=\"forminator-label\">Date <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-4-picker_6a0086b0b311a\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"yy-mm-dd\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"0\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"upload-10\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-10_6a0086b0b311a\" id=\"forminator-field-upload-10_6a0086b0b311a-label\" class=\"forminator-label\">Upload ID Documents of Card Holders<\/label><div class=\"forminator-file-upload \" data-element=\"upload-10_6a0086b0b311a\"><input type=\"file\" name=\"upload-10\" id=\"forminator-field-upload-10_6a0086b0b311a\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.json\" tabindex=\"-1\"><button id=\"forminator-field-upload-10_6a0086b0b311a_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-10_6a0086b0b311a\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-3\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-3-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"3\"\r\n\t\t\t\tdata-label=\"Page  3\"\r\n\t\t\t\tdata-actual-label=\"Page 4\"\r\n\t\t\t\tdata-name=\"page-break-7\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-7\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">AFFORDABILITY ASSESSMENT<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #037277;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-10\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Monthly Income<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-5\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-5_6a0086b0b311a\" id=\"forminator-field-currency-5_6a0086b0b311a-label\" class=\"forminator-label\">Gross Monthly Income <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-5\" value=\"\" placeholder=\"E.g. 80 000\" id=\"forminator-field-currency-5_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-5\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-5_6a0086b0b311a\" id=\"forminator-field-upload-5_6a0086b0b311a-label\" class=\"forminator-label\">Upload Proof of Income (Bank + Financial Statements)<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-5_6a0086b0b311a\" aria-describedby=\"forminator-field-upload-5_6a0086b0b311a-description\"><input type=\"file\" name=\"upload-5[]\" id=\"forminator-field-upload-5_6a0086b0b311a\" class=\"forminator-input-file forminator-field-upload-5_6a0086b0b311a-100425\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"12000000\" data-size-message=\"Maximum file size allowed is 12 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-5_6a0086b0b311a\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-5_6a0086b0b311a-description\" class=\"forminator-description\">Please attach 3 months latest bank statements and financial statements<\/span><ul class=\"forminator-uploaded-files upload-container-upload-5_6a0086b0b311a\"><\/ul><\/div><\/div><div id=\"upload-8\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-8_6a0086b0b311a\" id=\"forminator-field-upload-8_6a0086b0b311a-label\" class=\"forminator-label\">Upload Copy of Business Registration Document <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-multi-upload \" data-element=\"upload-8_6a0086b0b311a\" aria-describedby=\"forminator-field-upload-8_6a0086b0b311a-description\"><input type=\"file\" name=\"upload-8[]\" id=\"forminator-field-upload-8_6a0086b0b311a\" class=\"forminator-input-file-required do-validate forminator-field-upload-8_6a0086b0b311a-100425\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"12000000\" data-size-message=\"Maximum file size allowed is 12 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-8_6a0086b0b311a\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><span id=\"forminator-field-upload-8_6a0086b0b311a-description\" class=\"forminator-description\">CIPRO Documents<\/span><ul class=\"forminator-uploaded-files upload-container-upload-8_6a0086b0b311a\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-21\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Monthly Expenses<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-59\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-59_6a0086b0b311a\" id=\"forminator-field-currency-59_6a0086b0b311a-label\" class=\"forminator-label\">Accommodation Expense: Rent<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-59\" value=\"\" placeholder=\"E.g. 5000\" id=\"forminator-field-currency-59_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-29\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-29_6a0086b0b311a\" id=\"forminator-field-currency-29_6a0086b0b311a-label\" class=\"forminator-label\">Accommodation Expense: Rates and Taxes<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-29\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-29_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-28\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-28_6a0086b0b311a\" id=\"forminator-field-currency-28_6a0086b0b311a-label\" class=\"forminator-label\">Accommodation Expense: Electricity and Water<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-28\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-28_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-27\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-27_6a0086b0b311a\" id=\"forminator-field-currency-27_6a0086b0b311a-label\" class=\"forminator-label\">Transport Expense: Petrol<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-27\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-27_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-26\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-26_6a0086b0b311a\" id=\"forminator-field-currency-26_6a0086b0b311a-label\" class=\"forminator-label\">Transport: Maintenance<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-26\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-26_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-25\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-25_6a0086b0b311a\" id=\"forminator-field-currency-25_6a0086b0b311a-label\" class=\"forminator-label\">Communication: Mobile, Telkom, Internet<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-25\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-25_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-24\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-24_6a0086b0b311a\" id=\"forminator-field-currency-24_6a0086b0b311a-label\" class=\"forminator-label\">Other Expenses: Specify<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-24\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-24_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"name-24\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-24_6a0086b0b311a\" id=\"forminator-field-name-24_6a0086b0b311a-label\" class=\"forminator-label\">Expense Description<\/label><input type=\"text\" name=\"name-24\" value=\"\" placeholder=\"E.g. Subscriptions\" id=\"forminator-field-name-24_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-23\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-23_6a0086b0b311a\" id=\"forminator-field-currency-23_6a0086b0b311a-label\" class=\"forminator-label\">Other Expenses: Specify<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-23\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-23_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"name-26\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-26_6a0086b0b311a\" id=\"forminator-field-name-26_6a0086b0b311a-label\" class=\"forminator-label\">Expense Description<\/label><input type=\"text\" name=\"name-26\" value=\"\" placeholder=\"\" id=\"forminator-field-name-26_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-72\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-72_6a0086b0b311a\" id=\"forminator-field-currency-72_6a0086b0b311a-label\" class=\"forminator-label\">Other Expenses: Specify<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-72\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-72_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"name-25\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-25_6a0086b0b311a\" id=\"forminator-field-name-25_6a0086b0b311a-label\" class=\"forminator-label\">Expense Description<\/label><input type=\"text\" name=\"name-25\" value=\"\" placeholder=\"\" id=\"forminator-field-name-25_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-73\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-73_6a0086b0b311a\" id=\"forminator-field-currency-73_6a0086b0b311a-label\" class=\"forminator-label\">Vehicle Finance: Monthly Payment<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-73\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-73_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-75\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-75_6a0086b0b311a\" id=\"forminator-field-currency-75_6a0086b0b311a-label\" class=\"forminator-label\">Vehicle Finance: Capital Amount Outstanding<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-75\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-75_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-7\" class=\"forminator-field-calculation forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"calculation-7-field_6a0086b0b311a\" id=\"calculation-7-field_6a0086b0b311a-label\" class=\"forminator-label\">Total Company Expenses<\/label><input type=\"text\" name=\"calculation-7\" value=\"\" id=\"calculation-7-field_6a0086b0b311a\" class=\"forminator-calculation forminator-input\" data-formula=\"{currency-59}+{currency-29}+{currency-28}+{currency-27}+{currency-26}+{currency-25}+{currency-24}+{currency-23}+{currency-72}+{currency-73}\" data-required=\"\" data-decimal-point=\".\" data-precision=\"2\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" readonly=\"readonly\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-8\" class=\"forminator-field-calculation forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"calculation-8-field_6a0086b0b311a\" id=\"calculation-8-field_6a0086b0b311a-label\" class=\"forminator-label\">Net Monthly Income<\/label><input type=\"text\" name=\"calculation-8\" value=\"\" id=\"calculation-8-field_6a0086b0b311a\" class=\"forminator-calculation forminator-input\" data-formula=\"{currency-5}-{calculation-7}\" data-required=\"\" data-decimal-point=\".\" data-precision=\"2\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" readonly=\"readonly\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-83\" class=\"forminator-field-currency forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-83_6a0086b0b311a\" id=\"forminator-field-currency-83_6a0086b0b311a-label\" class=\"forminator-label\">Amount Available for Pretorium Trust Card <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-83\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-83_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-4\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-4-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"4\"\r\n\t\t\t\tdata-label=\"Page  4\"\r\n\t\t\t\tdata-actual-label=\"Page 5\"\r\n\t\t\t\tdata-name=\"page-break-10\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-17\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">STATEMENT OF ASSETS<\/h2><hr class=\"forminator-border\" style=\"border: 2px solid #00594a;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-18\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Fixed Property<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6a0086b0b311a\" id=\"forminator-field-text-17_6a0086b0b311a-label\" class=\"forminator-label\">Suburb<\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"E.g. Lynnwood\" id=\"forminator-field-text-17_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-62\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-62_6a0086b0b311a\" id=\"forminator-field-currency-62_6a0086b0b311a-label\" class=\"forminator-label\">Market Value<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-62\" value=\"\" placeholder=\"E.g. 1500000\" id=\"forminator-field-currency-62_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-65\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-65_6a0086b0b311a\" id=\"forminator-field-currency-65_6a0086b0b311a-label\" class=\"forminator-label\">Current Balance<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-65\" value=\"\" placeholder=\"E.g. 800000\" id=\"forminator-field-currency-65_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6a0086b0b311a\" id=\"forminator-field-text-18_6a0086b0b311a-label\" class=\"forminator-label\">Suburb<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-64\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-64_6a0086b0b311a\" id=\"forminator-field-currency-64_6a0086b0b311a-label\" class=\"forminator-label\">Market Value<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-64\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-64_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-66\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-66_6a0086b0b311a\" id=\"forminator-field-currency-66_6a0086b0b311a-label\" class=\"forminator-label\">Current Balance<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-66\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-66_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_6a0086b0b311a\" id=\"forminator-field-text-19_6a0086b0b311a-label\" class=\"forminator-label\">Suburb<\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-63\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-63_6a0086b0b311a\" id=\"forminator-field-currency-63_6a0086b0b311a-label\" class=\"forminator-label\">Market Value<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-63\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-63_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-67\" class=\"forminator-field-currency forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-67_6a0086b0b311a\" id=\"forminator-field-currency-67_6a0086b0b311a-label\" class=\"forminator-label\">Current Balance<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-67\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-67_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-19\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Movable Assets<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_6a0086b0b311a\" id=\"forminator-field-text-20_6a0086b0b311a-label\" class=\"forminator-label\">Item<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"E.g. Vehicle\" id=\"forminator-field-text-20_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-68\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-68_6a0086b0b311a\" id=\"forminator-field-currency-68_6a0086b0b311a-label\" class=\"forminator-label\">Market Value<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-68\" value=\"\" placeholder=\"E.g. 50000\" id=\"forminator-field-currency-68_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_6a0086b0b311a\" id=\"forminator-field-text-21_6a0086b0b311a-label\" class=\"forminator-label\">Item<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"E.g. Furniture\" id=\"forminator-field-text-21_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-70\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-70_6a0086b0b311a\" id=\"forminator-field-currency-70_6a0086b0b311a-label\" class=\"forminator-label\">Market Value<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-70\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-70_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_6a0086b0b311a\" id=\"forminator-field-text-22_6a0086b0b311a-label\" class=\"forminator-label\">Item<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"currency-69\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-69_6a0086b0b311a\" id=\"forminator-field-currency-69_6a0086b0b311a-label\" class=\"forminator-label\">Market Value<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-69\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-69_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-22\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Debtors<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-77\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-77_6a0086b0b311a\" id=\"forminator-field-currency-77_6a0086b0b311a-label\" class=\"forminator-label\">Amount Owed<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-77\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-77_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-80\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-80_6a0086b0b311a\" id=\"forminator-field-currency-80_6a0086b0b311a-label\" class=\"forminator-label\">Estimated amount recoverable<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-80\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-80_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-78\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-78_6a0086b0b311a\" id=\"forminator-field-currency-78_6a0086b0b311a-label\" class=\"forminator-label\">Amount Owed<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-78\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-78_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-81\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-81_6a0086b0b311a\" id=\"forminator-field-currency-81_6a0086b0b311a-label\" class=\"forminator-label\">Estimated amount recoverable<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-81\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-81_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-79\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-79_6a0086b0b311a\" id=\"forminator-field-currency-79_6a0086b0b311a-label\" class=\"forminator-label\">Amount Owed<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-79\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-79_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><div id=\"currency-82\" class=\"forminator-field-currency forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-currency-82_6a0086b0b311a\" id=\"forminator-field-currency-82_6a0086b0b311a-label\" class=\"forminator-label\">Estimated amount recoverable<\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-82\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-82_6a0086b0b311a\" class=\"forminator-input forminator-currency\" data-required=\"\" aria-required=\"\" data-decimals=\"2\" data-inputmask=\"'groupSeparator': '', 'radixPoint': '.', 'digits': '2'\" type=\"number\" step=\"any\" \/><span class=\"forminator-suffix\">ZAR<\/span><\/div><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-5\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-5-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"5\"\r\n\t\t\t\tdata-label=\"Page  5\"\r\n\t\t\t\tdata-actual-label=\"Page 6\"\r\n\t\t\t\tdata-name=\"page-break-8\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-12\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">CREDIT AND PAYMENT HISTORY<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #00726b;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a0086b0b311a-label\" class=\"forminator-label\">Under Administration or Debt Review? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-4-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Yes\" id=\"forminator-field-checkbox-4-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-4-1-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-4-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-4-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"No\" id=\"forminator-field-checkbox-4-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-4-2-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-4-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><span id=\"forminator-field-checkbox-4-6a0086b0b311a-description\" class=\"forminator-description\">In the past 3 months, have you applied for debt review or debt counseling or are presently under administration or debt review<\/span><\/div><\/div><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a0086b0b311a-label\" class=\"forminator-label\">Any disputes in process with a Credit Bureau? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-5-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-5-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Yes\" id=\"forminator-field-checkbox-5-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-5-1-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-5-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"No\" id=\"forminator-field-checkbox-5-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-5-2-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-4 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6a0086b0b311a-label\" class=\"forminator-label\">Lost Card Protection (optional) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-6-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-6-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes (R12)\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Yes-(R12)\" id=\"forminator-field-checkbox-6-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-6-1-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-6-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes (R12)<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-6-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"No\" id=\"forminator-field-checkbox-6-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-6-2-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-6-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><span id=\"forminator-field-checkbox-6-6a0086b0b311a-description\" class=\"forminator-description\">The 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.<\/span><\/div><\/div><div id=\"checkbox-16\" class=\"forminator-field-checkbox forminator-col forminator-col-4 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-16-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-16-6a0086b0b311a-label\" class=\"forminator-label\">Advance Payment Fund <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-16-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-16-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Agree\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"Agree\" id=\"forminator-field-checkbox-16-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-16-1-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-16-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Agree<\/span><\/label><span id=\"forminator-field-checkbox-16-6a0086b0b311a-description\" class=\"forminator-description\">The 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.<\/span><\/div><\/div><div id=\"text-40\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-40_6a0086b0b311a\" id=\"forminator-field-text-40_6a0086b0b311a-label\" class=\"forminator-label\">Other Contribution Value<\/label><input type=\"text\" name=\"text-40\" value=\"\" placeholder=\"E.g. R 40\" id=\"forminator-field-text-40_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-2\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a0086b0bb2e6\" id=\"forminator-field-ctlSignature6a0086b0bb2e6-label\" class=\"forminator-label\">Signature <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6a0086b0bb2e6_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a0086b0bb2e6_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a0086b0bb2e6\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-2\" value=\"6a0086b0bb2e6\" class=\"signature-prefix\"><\/div><\/div><\/div><\/div><\/div><div\r\n\t\t\t\ttabindex=\"-1\"\r\n\t\t\t\trole=\"tabpanel\"\r\n\t\t\t\tid=\"forminator-custom-form-100425--page-6\"\r\n\t\t\t\tclass=\"forminator-pagination\"\r\n\t\t\t\taria-labelledby=\"forminator-custom-form-100425--page-6-label\"\r\n\t\t\t\taria-hidden=\"true\"\r\n\t\t\t\tdata-step=\"6\"\r\n\t\t\t\tdata-label=\"Page  6\"\r\n\t\t\t\tdata-actual-label=\"Page 7\"\r\n\t\t\t\tdata-name=\"\"\r\n\t\t\t\thidden\r\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-13\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">CONSENT AND SUBMISSION<\/h2><h3 class=\"forminator-subtitle\">Required fields marked with *<\/h3><hr class=\"forminator-border\" style=\"border: 2px solid #028284;\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6a0086b0b311a-label\" class=\"forminator-label\">Do you wish to receive your statement via: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-7-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-7-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Email\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Email\" id=\"forminator-field-checkbox-7-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-7-1-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Email<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-7-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Post\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Post\" id=\"forminator-field-checkbox-7-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-7-2-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Post<\/span><\/label><\/div><\/div><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6a0086b0b311a-label\" class=\"forminator-label\">Would you like to be considered for an automatic annual credit limit increase? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-8-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-8-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Yes\" id=\"forminator-field-checkbox-8-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-8-1-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-8-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-8-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"No\" id=\"forminator-field-checkbox-8-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-8-2-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6a0086b0b311a-label\" class=\"forminator-label\">Do you choose to be excluded from telemarketing campaigns by or on behalf of the Credit Provider? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-9-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-9-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Yes\" id=\"forminator-field-checkbox-9-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-9-1-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-9-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-9-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"No\" id=\"forminator-field-checkbox-9-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-9-2-6a0086b0b311a-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6a0086b0b311a-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6a0086b0b311a-label\" class=\"forminator-label\">Would you like to be considered for any mass distributions of e-mails or sms messages conducted by the Credit Provider? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-10-1-6a0086b0b311a-label\" for=\"forminator-field-checkbox-10-1-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Yes\" id=\"forminator-field-checkbox-10-1-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-10-1-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-10-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-10-2-6a0086b0b311a-label\" for=\"forminator-field-checkbox-10-2-6a0086b0b311a\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"No\" id=\"forminator-field-checkbox-10-2-6a0086b0b311a\" aria-labelledby=\"forminator-field-checkbox-10-2-6a0086b0b311a-label\" data-calculation=\"0\"   aria-describedby=\"forminator-field-checkbox-10-6a0086b0b311a-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><span id=\"forminator-field-checkbox-10-6a0086b0b311a-description\" class=\"forminator-description\">Promotions by the Credit Provider on behalf of our suppliers<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-9\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-100425__field--select-9_6a0086b0b311a\" id=\"forminator-form-100425__field--select-9_6a0086b0b311a-label\" class=\"forminator-label\">Where did you hear about us? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-100425__field--select-9_6a0086b0b311a\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-9\" data-default-value=\"\" data-placeholder=\"Please select\" data-search=\"false\" data-search-placeholder=\"Please select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-100425__field--select-9_6a0086b0b311a-label\"><option value=\"\"  >Please select<\/option><option value=\"Member\"  data-calculation=\"0\">Member<\/option><option value=\"Online\"  data-calculation=\"0\">Online<\/option><option value=\"Social-Media\"  data-calculation=\"0\">Social Media<\/option><option value=\"Radio\"  data-calculation=\"0\">Radio<\/option><option value=\"Printed-Media\"  data-calculation=\"0\">Printed Media<\/option><option value=\"Other\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"text-29\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-29_6a0086b0b311a\" id=\"forminator-field-text-29_6a0086b0b311a-label\" class=\"forminator-label\">If referred, Member number?<\/label><input type=\"text\" name=\"text-29\" value=\"\" placeholder=\"\" id=\"forminator-field-text-29_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-13\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-100425__field--select-13_6a0086b0b311a\" id=\"forminator-form-100425__field--select-13_6a0086b0b311a-label\" class=\"forminator-label\">Preferred Payment Method? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-100425__field--select-13_6a0086b0b311a\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-13\" data-default-value=\"\" data-placeholder=\"Please select\" data-search=\"false\" data-search-placeholder=\"Please select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-100425__field--select-13_6a0086b0b311a-label\"><option value=\"\"  >Please select<\/option><option value=\"Debit-Order\"  data-calculation=\"0\">Debit Order<\/option><option value=\"Other\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-16\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Debit Order Instruction<\/h2><h3 class=\"forminator-subtitle\">(If applicable)<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a0086b0b311a\" id=\"forminator-field-text-9_6a0086b0b311a-label\" class=\"forminator-label\">Account Holder Name<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a0086b0b311a\" id=\"forminator-field-text-8_6a0086b0b311a-label\" class=\"forminator-label\">Account Number<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6a0086b0b311a\" id=\"forminator-field-text-14_6a0086b0b311a-label\" class=\"forminator-label\">Account Type<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"E.g. Current \/ Savings\" id=\"forminator-field-text-14_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a0086b0b311a\" id=\"forminator-field-text-6_6a0086b0b311a-label\" class=\"forminator-label\">Bank Name<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6a0086b0b311a\" id=\"forminator-field-text-10_6a0086b0b311a-label\" class=\"forminator-label\">Branch Number<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-100425__field--select-5_6a0086b0b311a\" id=\"forminator-form-100425__field--select-5_6a0086b0b311a-label\" class=\"forminator-label\">Date of Debit Order<\/label><select  id=\"forminator-form-100425__field--select-5_6a0086b0b311a\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-5\" data-default-value=\"\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-100425__field--select-5_6a0086b0b311a-label\"><option value=\"Last-working-day\"  data-calculation=\"0\">Last working day<\/option><option value=\"First-working-day\"  data-calculation=\"0\">First working day<\/option><\/select><\/div><\/div><div id=\"upload-7\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-7_6a0086b0b311a\" id=\"forminator-field-upload-7_6a0086b0b311a-label\" class=\"forminator-label\">Please upload Account Confirmation<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-7_6a0086b0b311a\"><input type=\"file\" name=\"upload-7[]\" id=\"forminator-field-upload-7_6a0086b0b311a\" class=\"forminator-input-file forminator-field-upload-7_6a0086b0b311a-100425\" multiple=\"multiple\" data-method=\"ajax\" data-size=\"12000000\" data-size-message=\"Maximum file size allowed is 12 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Drag and Drop (or) <a class=\"forminator-upload-file--forminator-field-upload-7_6a0086b0b311a\" href=\"#\" onclick=\"return false;\">Choose Files<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-7_6a0086b0b311a\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_6a0086b0b311a\" id=\"forminator-field-text-23_6a0086b0b311a-label\" class=\"forminator-label\">Signed at<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"E.g. Pretoria\" id=\"forminator-field-text-23_6a0086b0b311a\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a0086b0b311a\" id=\"forminator-field-date-2-picker_6a0086b0b311a-label\" class=\"forminator-label\">Date<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"\" id=\"forminator-field-date-2-picker_6a0086b0b311a\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"yy-mm-dd\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"0\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-2-picker_6a0086b0b311a-description\" \/><\/div><span id=\"forminator-field-date-2-picker_6a0086b0b311a-description\" class=\"forminator-description\">Date application completed<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-6\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a0086b0bb57e\" id=\"forminator-field-ctlSignature6a0086b0bb57e-label\" class=\"forminator-label\">Signature of Account Holder<\/label><div class=\"forminator-signature\" data-elementheight=\"180\" aria-describedby=\"forminator-field-ctlSignature6a0086b0bb57e-description\"><span id=\"ctlSignature6a0086b0bb57e_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a0086b0bb57e_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a0086b0bb57e\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-6\" value=\"6a0086b0bb57e\" class=\"signature-prefix\"><span id=\"forminator-field-ctlSignature6a0086b0bb57e-description\" class=\"forminator-description\">Debit Order approval.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-2\" class=\"forminator-field-consent forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-2_6a0086b0b311a\" id=\"forminator-field-consent-2_6a0086b0b311a-label\" class=\"forminator-label\">Cost of Credit <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-2_6a0086b0b311a__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-2\" id=\"forminator-field-consent-2_6a0086b0b311a\" value=\"checked\" aria-labelledby=\"forminator-field-consent-2_6a0086b0b311a-label\" aria-describedby=\"forminator-field-consent-2_6a0086b0b311a__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-2_6a0086b0b311a__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>I agree with the membership fees as per the <a rel=\"noopener\" target=\"_blank\" href=\"https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2025\/06\/Cost-of-Credit_New.webp\">Cost of Credit<\/a><\/p><\/div><\/div><\/div><\/div><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6a0086b0b311a\" id=\"forminator-field-consent-1_6a0086b0b311a-label\" class=\"forminator-label\">Terms and Conditions <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6a0086b0b311a__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6a0086b0b311a\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6a0086b0b311a-label\" aria-describedby=\"forminator-field-consent-1_6a0086b0b311a__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6a0086b0b311a__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>Yes, I agree with the <a href=\"https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2021\/05\/PrivacyPolicy-1.pdf\" target=\"_blank\" rel=\"noopener\">privacy policy<\/a> and <a href=\"https:\/\/www.bonuscard.co.za\/wp-content\/uploads\/2022\/06\/PT_TermsConditions.pdf\" target=\"_blank\" rel=\"noopener\">terms and conditions<\/a>.<\/p>\n<p>\u00a0<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-3\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-3_6a0086b0b311a\" id=\"forminator-field-consent-3_6a0086b0b311a-label\" class=\"forminator-label\">Confirmation of Application <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-3_6a0086b0b311a__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-3\" id=\"forminator-field-consent-3_6a0086b0b311a\" value=\"checked\" aria-labelledby=\"forminator-field-consent-3_6a0086b0b311a-label\" aria-describedby=\"forminator-field-consent-3_6a0086b0b311a__description\" 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