RIGHTCARS

APPLY FOR FINANCE

identification details

first name *

middle name

surname *

id number *

date of birth (ccyymmdd) *

Personal Details

preferred language

Not Selected

preferred contact method

Cell Phone

country of nationality

Not Selected

mobile type

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gender

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mobile number *

title

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phone number (h)

graduate

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e-mail address

marital status

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is work phone number a cell

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race/ethnic group

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phone number (w)

Residential Details

residential address 1

postal address

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residential address 2

postal address line 1

residential city

postal city

residential suburb

postal suburb

residential code

postal code

owner/tenant/lodger

Not Selected

outstanding bond balance

bonded via

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property current value

period at address (yy/mm)

period at previous address (yy/mm)

Employer Details

employer name (please capture exactly as per payslip)

occupation

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employer industry type

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Employment Type

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Employment Level

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Client Type

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Employer Address Line 1

Employer Address Line 2

Employer City

Company Year End:

Not Selected

employer Suburb

Postal Code

Period Employed (YY/MM)

Period Previously Employed (YY/MM)

Income Details

Source of income

Not Selected

Car allowance (Inc in Gross)

Monthly Commission (Inc in Gross)

Other Income

Net Take-home Pay *

Total Monthly Income

Gross Remuneration *

Expenses Detail

Bond Payment *

Telephone Payments

Rent *

Transport Costs

Bond Payment/Rent Total

Food and Entertainment

Rates, Water & Electricity

Education Costs

Vehicle Instalments (Excluding Instalments to be settled)

Maintenance

Personal Loan Repayments

Household Expenses

Credit Card Repayments

Other Expenses

Furniture Accounts

Loans repaid via payroll deduction

Clothing Accounts

TOTAL Expenses

Overdraft Repayments

Disposable Income

Policy/Insurance Payments

Guarantee Details

Surety

Not Selected

Surety Description

Guarantor

Not Selected

Guarantor Description

Co-Debtor

Not Selected

Co-Debtor Description

Payment History

Are You Currently Under Debt-Review?

Not Selected

Do you have a re-arrangement in place with any credit provider as a result of debt Counselling?

Not Selected

Are you currently under administration order or Curator Bonus?

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Have you ever been under administration order?

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Have you ever had a judgment against you to your knowledge?

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Do you have a dispute in progress with a credit bureau?

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Are you currently under sequestration order?

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Finance Details

Agreement

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Repayment Period

Not Selected

Payment Frequency

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Interest Rate: %

Rate Indicator

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Residual / Balloon Value: %

Deposit

Finance Initiation Fees

Not Selected

Pay in Advance

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Relative Details

First Name

Surname

Relation

Not Selected

Preferred Contact Method

Not Selected

Contact Number

Relative Address 1

Relative Address 2

Relative City

Relative Suburb

Postal Code

Banking Details

Bank Name

Not Selected

Account Number

Account Holder (Same as Applicant)

Account Type

Not Selected

Branch Code

Settle existing Instalment

Not Selected

payment Method

Not Selected

Account No. to settle

Bank Name (Account to be settled)

Not Selected

Monthly Instalment (Account to be settled)

Settlement Amount

Payment Date

Not Selected

Bank Branch

Permission and Consent

I hereby consent to the Credit Provider accessing my credit profile from the credit bureaus for the purposes of a credit assessment and in the event that my loan application is successful, for on-going account maintenance purposes, setting limits, development of credit tools/products/models and insurance purposes.

I agree

Do you consent to your information being shared in order to receive marketing regarding insurance and related products?

I agree

I do not agree