CORPORATE APPLICATION FORM BUSINESS INFORMATION Required fields marked with * Name of Business * Trading Name Registration Number * Email * Business Phone Business Mobile * Business Physical Address *Business Address Business Postal AddressBusiness Postal Address Upload Proof of Physical Address Choose FileNo file chosenDelete uploaded file LanguagePlease selectEnglishAfrikaansSelect Language Do you own fixed property? *Please selectYesNo If not, do you: RentOther Were you previously a member of Pretorium Trust?YesNo If 'Yes' Membership Number INFORMATION OF BUSINESS OWNER Required fields marked with * Surname * Intials * Business Phone Mobile * Street Address * Suburb * City * Province * Postal Code * INFORMATION OF BUSINESS ASSOCIATE Required fields marked with * Surname Intials Business Phone Mobile Street Address Suburb City Province Postal Code AUTHORISED CARD HOLDERS Required fields marked with * Title and Initials * Surname * ID Number *Please insert a valid 13-digit South African ID number0 / 13 Card Limit ZAR Signature * Start signing your signature here Your browser does not support e-Signature field. Title and Initials Surname ID Number0 / 13 Card Limit ZAR Signature Start signing your signature here Your browser does not support e-Signature field. Title and Initials Surname ID Number0 / 13 Card Limit ZAR Signature Start signing your signature here Your browser does not support e-Signature field. Title and Initials Surname ID Number0 / 13 Card Limit ZAR Signature Start signing your signature here Your browser does not support e-Signature field. Total monthly purchase limit applied for * ZAR Budget limit applied for * ZAR Date * Upload ID Documents of Card Holders Choose FileNo file chosenDelete uploaded file AFFORDABILITY ASSESSMENT Required fields marked with * Monthly Income Gross Monthly Income * ZAR Upload Proof of Income (Bank + Financial Statements) Drag and Drop (or) Choose Files Please attach 3 months latest bank statements and financial statements Upload Copy of Business Registration Document * Drag and Drop (or) Choose Files CIPRO Documents Monthly Expenses Accommodation Expense: Rent ZAR Accommodation Expense: Rates and Taxes ZAR Accommodation Expense: Electricity and Water ZAR Transport Expense: Petrol ZAR Transport: Maintenance ZAR Communication: Mobile, Telkom, Internet ZAR Other Expenses: Specify ZAR Expense Description Other Expenses: Specify ZAR Expense Description Other Expenses: Specify ZAR Expense Description Vehicle Finance: Monthly Payment ZAR Vehicle Finance: Capital Amount Outstanding ZAR Total Company Expenses Net Monthly Income Amount Available for Pretorium Trust Card * ZAR STATEMENT OF ASSETS Fixed Property Suburb Market Value ZAR Current Balance ZAR Suburb Market Value ZAR Current Balance ZAR Suburb Market Value ZAR Current Balance ZAR Movable Assets Item Market Value ZAR Item Market Value ZAR Item Market Value ZAR Debtors Amount Owed ZAR Estimated amount recoverable ZAR Amount Owed ZAR Estimated amount recoverable ZAR Amount Owed ZAR Estimated amount recoverable ZAR CREDIT AND PAYMENT HISTORY Required fields marked with * Under Administration or Debt Review? *YesNoIn the past 3 months, have you applied for debt review or debt counseling or are presently under administration or debt review Any disputes in process with a Credit Bureau? *YesNo Lost Card Protection (optional) *Yes (R12)NoThe member confirms that he is aware of the Card Protection Fund offered by Pretorium Trust and that he must apply in writing for protection under the scheme. In terms of Pretorium Trust's Protection Fund Scheme, the member accepts liability for all payments made by Pretorium Trust or which Pretorium Trust is bound to make in respect of, or arising from, any use of the card before Pretorium Trust is reasonably able to act after receipt of the written notification by the member that the card is lost or stolen. Please debit my Pretorium Trust account annually with (R12 per card) in respect of the purchase cards issued on my membership number and include my name on the list of members of the Purchase Card Safeguarding Fund. Advance Payment Fund *AgreeThe member must contribute to the Advance Payment Fund at a minimum of R25 per month to a maximum of twice the monthly purchase limit. Please debit my account monthly with R25. Other Contribution Value Signature * Start signing your signature here Your browser does not support e-Signature field. CONSENT AND SUBMISSION Required fields marked with * Do you wish to receive your statement via: *EmailPost Would you like to be considered for an automatic annual credit limit increase? *YesNo Do you choose to be excluded from telemarketing campaigns by or on behalf of the Credit Provider? *YesNo Would you like to be considered for any mass distributions of e-mails or sms messages conducted by the Credit Provider? *YesNoPromotions by the Credit Provider on behalf of our suppliers Where did you hear about us? *Please selectMemberOnlineSocial MediaRadioPrinted MediaOther If referred, Member number? Preferred Payment Method? *Please selectDebit OrderOther Debit Order Instruction (If applicable) Account Holder Name Account Number Account Type Bank Name Branch Number Date of Debit OrderLast working dayFirst working day Please upload Account Confirmation Drag and Drop (or) Choose Files Signed at Date Date application completed Signature of Account Holder Start signing your signature here Your browser does not support e-Signature field. Debit Order approval. Cost of Credit * I agree with the membership fees as per the Cost of Credit Terms and Conditions * Yes, I agree with the privacy policy and terms and conditions. Confirmation of Application * I/we hereby confirm that I/we have answered all your questions and relevant information fully and truthfully as part of this assessment process. I/we hereby confirm that I/we have fully disclosed my/our debt repayment history Signature * Start signing your signature here Your browser does not support e-Signature field. SubmitSave as Draft
