TEL :
031 492 2859
ADDRESS :
117 Josiah Gumede Road, Pinetown, 3610
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031 207 2888
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Sales Representative
-Select Sales Representative (Not Required)-
Kevin Pottow
Sbu Ncanana
Shuaib Amod
Tyron Moodley
Which Vehicle (ie 2010 2.0)
-SELECT-
2018 Red Kia Sportage
2022 White Volkswagen Polo
2021 Whte Volkswagen Polo
2017 Silver Volkswagen Golf
2019 Silver Volkswagen Polo
2021 White Ford Ranger
2021 White Suzuki Ertiga
2014 Black Mercedes-Benz C Class
2021 Red Hyundai Atos
2018 Blue Renault Kadjar
2021 Grey Suzuki Vitara Brezza
2022 White Renault Kiger
2022 Black Chery Tiggo 4 Pro
2017 Silver Audi A3
2020 Blue Hyundai Venue
2021 Red BMW M3
2023 Blue Citroen C3
2023 Silver Hyundai i10
2022 WHITE Toyota Starlet
2021 Grey Volkswagen Polo Vivo
2020 White Hyundai i20
2021 Silver Suzuki Ertiga
2023 White Hyundai i10
2021 White Toyota Corolla
2020 Grey Citroen C3 Aircross
2022 Grey Suzuki Vitara Brezza
2021 Red Mazda CX-30
2019 Silver Audi A3
2021 Green Renault KWID
Personal Details
Title
Not Selected
Advocate
Doctor
Mr
Miss
Mrs
Reverend
Professor
Surname
Full Names
Cell Number
Email Address
Sex
-
Male
Female
ID Number
No. Of Dependants
Marital Status
Not Selected
Divorced
Married
Single – Adult
Single - Young
Widow/er
Marital Contract
Not Selected
Antenuptual Contract
In Community of property
Traditional Marriage
Married in COP (Chapter 2 & 3)
Married in COP ( not Chapter 2 & 3)
Foreign/Custom
Date of Marriage (dd/mm/yyyy):
DAY
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DAY
MONTH
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YEAR
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
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1981
1982
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1990
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2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Home Address :
Street 1:
Street 2:
Street 3:
Suburb :
City :
Postal Code:
How long have you stayed at this address? (Years/Months):
Postal Address :
Postal Address:
P.O. Box 1 :
P.O. Box 2 :
P.O. Box 3 :
P.O. Box Suburb :
P.O. Box City :
P.O. Box Postal Code :
Telephone(Home):
Telephone(Work):
Spouse Name(if Married):
Spouse ID(if Married):
Spouse Cell Number(if Married):
Details of Somebody NOT Living With You
Name:
Surname:
Cell Number:
Relationship
-
Friend
Family
Boss
Address:
Employer Details
Employers Company Name:
Managers Name:
Occupation
Not Selected
Able Seaman
Accommodation Occupations
Accountant/Auditor
Actor or Actress
Admin Assistant
Admin Clerk
Admin Manager
Admiral
Advocate
Air Transport Occupations
Ammunition Seeker
Anaesthetist
Appraiser
Apprentice
Architect
Area Manager
Artisan
Artist
Assembler
Assessor
Assistant
Assistant Manager
Assistant to the Trades
Attorney
Auctioneer
Author
Baker
Bank Employee
Bank Teller
Barmaid
Barman / Bartender
Beautician
Biologist
Boilermaker
Bombardier
Book Maker
Bookkeeper
Bricklayer
Brigadier
Broker
Builder
Building Contractor
Building Inspector
Building Painter
Business Consultant
Butcher
Buyer
Cabinet Maker
Cabinet Minister
Cable Joiner
Candidate Officer
Captain
Carpenter / Joiner
Carpenter or Joiner
Cashier
Casting Worker
Catering Occupations
Chairman of Company
Chartered Accountant
Chefs
Chemist
Chief Petty Officer
Chiropracter
Civil Servant
Co-ordinator
Colonel
Commander
Commandore
Commissioner
Computer Operator
Computer Programmer
Computer System Analyst
Constable
Consultants
Cook
Copywriter
Corporal
Credit Collector or Personnel
Dance Instructor
Data Puncher
Dean
Debtors / Creditors Clerk
Dental Assistant
Dentist
Designer
Diplomat - not RSA Citizen
Director
District Manager
Doctor / General Practitioner
Draughtsman
Driver - Vehicle
Electrician
Engineer
Ensign
Estate Agent
Extension Officer - Agricultural
Factory Worker
Farm Foreman
Farm Worker
Farmer (Private Capacity)
Farmer Parttime
Farmer ie Grower
Financial Advisors
Fireman
Fisherman or Hunter
Fisherman/Hunter
Fitter And Turner
Flight Sargeant
Foreman
Forensic Analyst
Foundry Worker
Funeral Director
General
General Manager - Company
Geologist
Glazier
Government Employees
Graphic Designer
Grinder
Gynecologist
Hairdresser / Barber
Head of Technikon/College/School
Headmaster
Housekeeper
Housewife
IT/IT Technician
Inspector
Inspector of Schools
Insurance Agent
Insurance Broker
Insurance Consultant
Interior Decorator
Iron Worker
Jeweller
Journalist
Judge
Labourer / Unskilled Labourer
Labourer or Unskilled Labourer
Laundryman
Lay preacher
Leading Seaman
Lecturer
Legal Professions Other
Librarian
Lieutenant
Lieutenant Colonel
Lieutenant Commander
Lieutenant General
Lumberman
Machine Operator
Machinist
Major
Major General
Manager
Managing Director
Market Checker
Mason
Mechanic
Medic
Medical Doctor
Member of Parliament
Member of Provincial Council
Metal Worker
Meter Reader
Midshipman
Millwright
Mine Worker
Minister
Missionary
Model
Moulder
Municipal Servant
Musician
Nurse
Nursery Worker
Nursing Sister
Office Worker
Officer
Operator/Production Worker
Optician
Other Occupations Not Mentioned
Packer
Painter
Painter - Buildings
Paramedics
Part time / Contract Worker
Pensioner
Personnel Occupations
Petty Officer
Pharmacist
Photographer
Pilot
Pipefitter
Plasterer
Plumber
Police Officer
Porter
Postal Services Occupations
President
Priest
Prison Officer
Private
Production Control
Production Line Worker
Professor
Prospector
Psychiatrist
Psychologist
Quality Control
Quality Surveyor
Radio Announcer
Rail Transport Occupation
Rear Admiral
Receptionist
Rector
Regional Manager
Repair Man
Reporter
Researchers
Retired
Rigger / Scaffolder
Road Transport Occupations
Safety Officer
Salesman
Salesman/Marketer
Sargeant
Sargeant Major
Scholar
Scientist
Sculptor
Sea Transport Occupations
Seaman
Second Bombardier
Second Corporal
Second Lieutenant
Secretary
Security Guard
Security Officer
Self Employed(Professional)
Self Employed(non-professional)
Senator
Senior Executive Consultant
Senior Superintendent
Serviceman
Shopfitter
Singer
Slaughterman
Social Worker
Soldier
Sole Owner
Sole Owner - Individual(retail bank)
Sole Owner(Business Bank)
Specialist
Sport Occupations
Spray Painter
Staff Sargeant
Stage Artist
Steel Worker
Steeplejack
Stock Controller
Student
Sub-Lieutenant
Superintendent
Supervisor
Surgeon
Surveyor
Taxi Owner / Driver
Teacher
Technician
Telecommunication Occupation
Telephonist
Therapeutist
Traffic Officer
Train Driver
Transport Contractor
Typist
Unemployed
Veterinarian
Vice Admiral
Vice Corporal
Waiter
Warrent Officer
Welder
Zoologist
How long have you worked there?:
Employers Address:
Employers Telephone:
What date do you get paid:
Banking Details
Who do you Bank With?
Not Selected
ABN AMRO BANK
ABSA BANK
ABSA-ITHALA
AFRICAN BANK
AL BARAKA
ALPHERA FINANCE
AUDI FINANCIAL SERVICES
BANK OF ATHENS
BANK WINDHOEK
BIDVEST BANK
BMW FINANCE
BOE BANK (NEDBANK)
CAPITEC BANK
CITIBANK
FBC FIDELITY BANK LTD
FIRST NATIONAL BANK
GRINDROD BANK
HABIB OVERSEAS BANK
HBZ BANK
INVESTEC BANK LIMITED
MERCANTILE BANK
NBS (NEDBANK)
NEDBANK
NEDBANK (Lesotho)
NEDBANK (Namibia)
NEDBANK (Swaziland)
OTHER
PEP BANK (NEDBANK)
RESERVE BANK
SA BANK OF ATHENS
SA POST OFFICE
STANDARD BANK
STANDARD BANK (SWAZILAND)
STANDARD CHARTERED BANK (20TWENTY)
STANDARD LESOTHO BANK LIMITED
TEBA BANK
TOYOTA FINANCIAL SERVICES
UNIBANK LIMITED
VOLKSWAGEN FINANCIAL SERVICES
WESBANK
Type of Account?
-
Cheque
Transmission
Savings
Bank Branch Name?:
Bank Account Number?
Bank Branch Number?
Name of Account Holder
Income and Expenses
Total Income Before Deductions
Total Income After Deductions
Total Expenses ie Rent, Vehicles, Food, Telephone, Electricity, etc
Breakdown of Expenses
Bond Payment / Rent
Rates, Water, & Electricity
Vehicle Installments
Personal Loan Repayments
Credit Card Repayments
Furniture Accounts
Clothing Accounts
Overdraft Repayments
Insurance Repayments
Telephone Payment
Transport Costs
Food and Entertainment
Education Costs
Maintenance
Household Expenses
Other
Agreement
By checking the check box below I hereby give consent to the Credit Provider to make enquiries about my credit record with any of credit agencies and to obtain whatever information on me that they might require to process the credit application and / or application for insurance. I hereby declare that all of the above information is true and correct . I also consent to all related parties for the collection and use of this information. *
SUBMIT
Finance application
IF YOU DO NOT OWE ANYTHING OR DO NOT HAVE ANY DETAILS, FILL IN WITH A 0
By clicking the following check boxes, I confirm that:*
I am a South African Citizen with a valid ID Book / ID Card
I am 18 years or older
I earn more than R10,000-00 nett per month
I am able to provide 3 months payslips and 3 months bank statements
I have a valid South African Driver’s License
I have not defaulted on any of my debts, nor do I have any judgements against me for accounts not paid
I confirm that I am currently not blacklisted with a financial institution
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