Individual Application for Finance

Complete the full individual finance application form below.

Individual Application For Finance

Marketer

Analyst

Date

Applicant Type

Applicant Type*

Identity/Passport Number*

Please Attach Copies of ID's*

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Remaining attachment capacity: 10 files, 20 MB

Citizenship*

If not South African resident, state country of residence.

Country of Residence

Permit Type

Permit Number

Surety Identity Number (If Applicable)

Permit Expiry

Transaction Type

Language Preference

Ethnic Group

Applicant Details

Title*

Initials*

Surname*

First Name*

Middle Name

Graduate

Trading As*

Gender

VAT Number

Email Address*

Cellphone Number*

Tax Number*

Home Address*

Home Telephone Number*

City*

Suburb*

Postal Code*

Period Residing at Property (YY/M)

Postal Address (If different from residential address)

Suburb

City

Pre-Screen Questions

Are you currently under debt review?*

Are you currently under sequestration?*

Are you currently under an administration order?*

Any court judgements?*

Are you a public official in a position of authority?*

Are you related to or associated with a public official in a position of authority?*

Personal Details

Marital Status*

Number of Dependents

Date Married

Spouses Details:

First Name

Surname

Spouses Identity Number

Gross Monthly Income

Spouses Employer Name

Spouses Employers Address

Suburb

Postal Code

Relatives Details

(Nearest Relative In SA Not Living With You)

Relative 1:

Relationship

Relatives Telephone Number

Surname

First Name

Relatives Address

Relative 2:

Relationship

Relatives Telephone Number

Surname

First Name

Relatives Address

Employment Details

Name

Address

Employer Contact Number

Suburb

Business Telephone Number

Employee Number

Type of Industry

Occupation

Period at Employer:

Years

Months

Previous Employment Details

Period at Employer:

Years

Months

Name

Address

Suburb

Postal Code

Employer Contact Number

Occupation

Home Ownership

Do you own a property?*

Home Loan Held With*

Suburb

Bond Amount Outstanding

Bonded/Rental Payment per month

Purchase Price

Current Value

Bond Holders Name

If a Flexi/Access Bond, Total Facility Granted

Existing &/ Account With Credit Providers

Branch Number

Account Number

Account Name

Installment per month

Number of Installments

Current

Paid Up

To be settled

Year Model

Dealer Name

Transaction Details

Asset Details

M & M Code

Salesman

Contract Term

Dealer Telephone Number

Deposit Percentage

Contract Type

Payment Frequency

Special Requirements

Purpose of Goods

Residual Value

Applicants Financial Details (Asset)

Selling Price (VAT Inclusive)

Extras

Amount

Total of Extras

Delivery Fee

License and Registration Costs

Deposit

Comprehensive Vehicle Insurance

Existing Insurance Company Name:

Broker Name:

Telephone Number:

Applicants Income Details

Applicants Income:

Gross Remuneration*

Income Other Than Salary/Wages*

Monthly Commission*

Net Take Home Pay*

Car Allowance Included in Gross*

Total Monthly Income

Applicants Expenses:

Bond Payment/Rent*

Policy/Insurance Repayments*

Rates, Water and Electricity*

Telephone Payment*

Vehicle Installments*

Transport Costs*

Personal Loan Repayments*

Food and Entertainment*

Credit Card Repayments*

Education Costs*

Furniture Accounts*

Maintenance*

Clothing Accounts*

Household Expenses*

Overdraft Repayments*

Other*

Total Monthly Expenses

Applicants Disposable Income

Date of Remuneration Received*

Are you currently liable as?

Specify Details

Landlords Details

(Name & Address Of Landlord Where Goods Will Be Kept If Applicable)

Landlord's Name

Landlord's Address

Suburb

Postal Code

Banking Details

Name of Business Bank*

Overdraft Limit*

Bank Account Number*

Please attach your last three months bank statements:*

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Remaining attachment capacity: 10 files, 20 MB

Other Financiers

Financial Institute

Facility Type

Facility Limit

Utilization

How are these facilities secured?

FICA Required Documents

Proof of Address*

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Remaining attachment capacity: 10 files, 20 MB

SARS VAT Registration Form*

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Remaining attachment capacity: 10 files, 20 MB

Account Information

Name of Accountant

Contact Person

Number of Years at Accountant

Contact Number

Address of Accountant

Postal Code

I Confirm That -

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 National Credit Act.

If any of the above is incorrect, state which and give details.*

May we contact you to inform you of our other products and services which may include special offers, upgrades and or new products?

May we contact you to inform you about products and services that third parties offer?*

May we or a company contracted to us, contact you for research purposes?*

May we include you in any mass distribution of e-mails or SMS messages.*

> I understand that I will be liable for a monthly service fee.

> I consent to this Credit Provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider's obligation under the National credit Act.

> I hereby declare that the information provided by me is true and correct.

> I consent to identify and fraud prevention checks and sharing information relating to this application through the South African Fraud Prevention Service.

> If you are married in community of property you are required to obtain the written consent of your spouse, in terms of the Matrimonial Property Act of 1984, before entering this agreement.

I confirm that the required consent is held.*

I confirm that the required consent is not held.*

I give consent to Route Quest to do back ground checks (e.g. ITC etc.)*

Please click on below link to Read/Accept "Privacy Notice" (Once you have Accepted and Submitted Privacy Notice form, return to this form to complete as well)

https://routemanagementgroup.docuware.cloud/DocuWare/Platform/WebClient/Forms/privacy-notice?orgID=ae9845fe-280b-4885-bd6e-3c3f42a6b96d

Please confirm if you have filled and accepted our "Privacy Notice"*

Signature of Applicant*

Date Signed*

Route Quest (Pty) Ltd (Reg. No. 1966/007740/07) Authorized financial services provider. (FSB License Nr: 28260)