Finance Application – Prime Auto

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Mon - Fri 8.00 - 17.00 Sat - 8.00 - 13.00
90 Leyds street Rustenburg
0145942268

Cell 0824372260

Email: primeauto@mweb.co.za

90 Leyds Street, Rustenburg View on map

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Finance Application

FILL IN THE FORM BELOW

PERSONAL INFORMATION

Title *

First Name *

Second Name

Surname *

Email Address *

Phone Number

ID/ Passport Number *

SA Citizenship *YesNo

Country of Origin *

Marital Status *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Document Upload *

Drag and Drop (or) Choose Files

Please upload all necessary documents. Formats: JPG, PNG, PDF (Size Limit 15mb) * Valid Drivers License copy * RSA Barcoded ID copy * Proof of physical address – water/lights account * Completed e-application * Three months proof of income, e.g. pay slips

Spouse Name *

Spouse Surname *

Spouse ID *

Spouse Date of Birth

Spouse Employer *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

RELETIVE DETAILS

Name *

Surname *

Relationship *

Phone *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

EMPLOYMENT DETAILS

Company Name *

Employer Name & Surname *

Phone *

Employer Email Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Industry Type *

Occupation *

Period *

BANKING DETAILS

Bank Name *

Account Holder's Name *

Account Number *

Account Type *

Branch Code *

INCOME DETAILS

Basic Salary *

Car Allowance *

Income Other Than Salary *

Total Monthly Income *

Net take home pay *

Spouse Income *

Other income sources *

HOUSEHOLD EXPENSES

Bond Payments/Rent (R) *

Policy / Insurance Repayments (R) *

Rates & Taxes / Water & Electricity (R) *

Telephone Payments (R) *

Vehicle Installments (R) *

Transport Cost (R)

Personal Loan Repayments (R)

Food & Entertainment (R)

Credit Card Repayments (R)

Education Cost (R)

Clothing Accounts (R)

Household Expenses (R)

Medical Aid (R)

Total Monthly Expenses

I hereby confirm that:I am not a minor, a Court has never declared me mentally unfit, I am not subject to an administration order, I do not have any current application pending for debt restructuring or alleviation, I do not have any current debt re-arrangement in existence., I have not previously applied for a debt re-arrangement, I am not under sequestration, I do not have applications pending for credit, nor open quotation as envisaged in section 92 of the national act.

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