One Pager Appl New

Consultants : PAUL

Contact our Specialist Consultant on: Tel: 072 325 5790 Fax: 086 694 7553

iDebtAssist

: 072 325 5790

Purpose of application: New Loan

Advance on existing loan

Personal details (Applicant): Surname Name ID No Tel (W) Fax No Cell Dependants

Monthly Expenses

R

Amount

Type / Service

Personal details (Co-Applicant): Surname Name ID No Tel (W) Fax No. Cell Period at current address Yrs

Ethnic

Bond / rental Lease Agree Credit card Insurance Fuel / Travel Education Loan Payments Mnths

Physical address

Groceries

Postal address

Postal code

Single

Marital status (√)

Electricity / Water

Married ANC

Employment / Salary Details (Applicant)

Employer

COP

Divorced

Employment / Salary Details (Co-Applicant/Surety)

Clothing Medical Accounts Telephone Domestic Wages

Occupation

Employer Occupation

Employer Address

Employer Address

TV / M-Net / DSTV

Employment period

Employment period

R R R

Basic Salary Average Overtime Other source of income

Entertainment

R R R

Basic Salary Average Overtime Other source of income

Highest qualification Income Tax nr: Type Bond Cheque

Account number

2. 3.

Institution

Total expenses ! Kindly supply the following!

Type Bond Cheque

Savings Vehicle

Savings Vehicle

Account number

Copy of ID/s of the participants 3 Most recent salary advice 3 Months Bank statements 6 Months Bond statements Title Deed (if applicable) Marriage certificate • If married in C.O.P. forward both parties details & documents • Water and Lights account

Security (Fixed property details) Sub / Ext City

Physical Address

Postal Address

Code

Bank Name

Purchase Date

R

Purchase Price

R

•

OWN BUSSINESS (if applicable) • 6 Months Bank Statements • Financial Statements for the last year • Auditor’s letter

Bond Acc No

R

Square m²

Mark: Instalment to be paid: Direct Debit ________ Salary Stop Order ________

Assets Fixed properties (Total) 1. 2.

R R

Vehicles (Make/Model) 1. 2.

Furniture / Household Life Insurance Policies Investments Credit (All Accounts) Other (Specify)

Total Assets

1.

4.

Credit Card

Loan Amount Required

Other (Specify)

List of Existing Accounts (Co-applicant/Surety)

Credit Card

Stand No.

Market value

Donations

Highest qualification Income Tax nr:

List of Existing Accounts (Applicant)

Institution

Alimony

Amount

R R R R R R R R R R R R R R R R R R R R R R R

Liabilities Fixed properties (Total) 1. 2.

R R

Vehicles (Make/Model)

R R R R R R R R

1.

R

Total Liabilities

2.

Furniture / Household Outstanding Bonds Bank loans Credit Cards Other (Specify)

R R R R R R R R R

*Please note that both the applicant’s and the co-applicant / surety’s salary slip, bank and bond statements must be submitted. I/we declare that the foregoing information is correct. I/we consent to idebtassist making credit enquiries in order to consider this application, and to make available details regarding the management of my / our account/s to credit reference agencies. I we give permission to idebtassist for obtaining information on my / our insurance portfolio in order to assist me / us with my financial planning.

______________________________ Applicant Date _______________________________ Co-Applicant Date

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