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APPLICATION FOR INSTALMENT FINANCE

Personal Details

Title

First Name

Middle Name

Surname

ID Number:

GenderChoose Gender

Ethnic GroupChoose Ethnic Group

Language PreferenceChoose Language Preference

Marital StatusChoose Marital Status

Date Married

Email Address

Home Phone

Work Phone

Cell Phone

Home Address

Home City

Home Province

Home Postal Code

Home Country

Years at Home Address:

Postal Address

Postal City

Postal Province

Postal Code

Postal Country

Years at Postal Address:

Previous Address

Previous City

Previous Province

Previous Code

Previous Country

Years at Previous Address:

Spouse Details

Spouse Title

Spouse Name

Spouse Middle Name

Spouse Surname

Spouse ID Number

Next Of KIN Details

Next Of KIN – Title

Next Of KIN – Name

Next Of KIN – Surname

Next Of KIN – Relationship

Next Of KIN – Phone

Next Of KIN – Address

Next Of KIN – City

Next Of KIN – Province

Next Of KIN – Code

Next Of KIN – Country

Next Of KIN – Years at Address

Bond Details

Bond Holder

Bond Amount Outstanding

Property Value

Installment P/M

Purchase Price

Date Purchased

Registered:Choose One

Renting

Employer Details

Employer Name

Occupation

Employer Street Address

Employer Apartment, Suite, etc

Employer City

Employer Province

Employer Postal Code

Employer Country

Years at Employer

Employer Phone

Salary Date

Previous Employer Details

Previous Employer Name

Years at Previous Employer

Spouse Employer Details

Spouse Employer Name

Years at Spouse Employer

Spouse Employer Phone

Spouse Occupation

Bank Details

Bank Name

Branch Name

Branch Code

Name Of Account Holder

Account Number

Select Account Type

Trade Reference

Branch

Account Number

Installments

A. I am not a minor.

B. I have never been declared mentally unfit by a court.

C. I am not subject to an administration order.

D. I do not have any current application pending for debt restructuring or alleviation.

E. I do not have any current debt re-arrangement in existence.

F. I have not previously applied for a debt re-arrangement.

G. I am not under sequestration.

H. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.

I hereby confirm that all of the above information is true and correct.YesNo

If any of the above is incorrect give details:0 / 300

Declaration By Client:

I hereby grant the Credit Provider the right to communicate with me through any electronic/written media or verbally in order to make available to me, their product offering..YesNo

I hereby grant the Credit Provider the right to increase my Credit Limit once every year to accommodate any value Added Products needed and requested by me.YesNo

I hereby give consent to the Credit Provider to make enquires about my credit record with any credit agency and to obtain whatever information on me they might require to process the application. I also give consent to the Credit Provider to share my payment behavior with any credit agency.YesNo

I hereby declare that all of the above information is true and correct.YesNo

Declaration Date

Unlocking Your Automotive Potential

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CONTACT US

11 Main Road, Newlands, Johannesburg, 2092
+27 11 470 0393
+27 82 646 1713
info@cdautotrade.co.za
Mon to Fri - 8am to 5pm
Saturdays - 8am to 3pm
Sundays - Closed

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