Blacklisted Car Finance Application Form

Complete our quick Application Form online to get a provisional approval. Please note that a final approval is subject to validations, substantiating documentation, and the fulfillment of the company terms and conditions

Personal Details
Title*
ID Number*
First Name*
Middle Name
Last Name*
Gender*
Cell Number:*
Work Number:*
Email Address*
Residential Address Line 1*
Residential Address Line 2*
City*
State/Province*
ZIP/Postal*
Period At Residence*
In Year/Months
Previous Residential Address Line 1*
Previous Residential Address Line 2*
City*
State/Province*
ZIP/Postal*
Postal Address Line 1*
Postal Address Line 2*
City*
State/Province*
ZIP/Postal*
Residential Type*
Residential Monthly Payments*
Marital Status*
Type of Marriage
Date Married
Spouse Name
First Name
Last Name
Spouse ID Number:
Spouse Contact Number:
Spouse Employer Name:
Company Name
Spouse Occupation:
Spouse Work Number:
Spouse Employment Period:*
In Year/Months
Next of Kin (NOT SPOUSE)*
First Name
Next of Kin (NOT SPOUSE)*
Last Name
Next of Kin Contact Number:*
Next of Kin Relationship:*
Next of Kin Address Line 1*
Next of Kin Address Line 2*
City*
Province*
ZIP/Postal*
Employment Details
Employer Name*
Company Name
Occupation*
Employer Address Line 1*
Employer Address line 2*
City*
State/Province*
ZIP/Postal*
Period of Employment:*
In Year/Months
HR Contact Name:*
First Name
HR Contact Name:*
Last Name
HR Number*
Salary Date*
Previous Employer Name:*
Company Name
Period of Previous Employment:*
In Year/Months
Banking Details
Name of account Holder*
Bank Name*
Branch Code:*
Branch Name*
Account Number:*
Account Type:*
Income Breakdown
Own Basic Monthly (excl Car Allowance)*
Spouse Basic Monthly (excl Car Allowance):*
Own Car Allowance:*
Spouse Car Allowance:*
Own Total Salary (Basic + Car Allowance):*
Spouse Total Salary (Basic + Car Allowance):*
Own Monthly Commission:*
Spouse Monthly Commission:*
Own Net Take Home Pay:*
Spouse Net Take Home Pay:*
Own Income Other than Salary/Wages:*
Spouse Income Other than Salary/Wages:*
Source Of Other Income:*
Total monthly Household Income (Net Salary & Other):*
Looking for a Bakkie or a Car ?*
Preferred Province*
Preferred Branch*
Declaration & Consent*
- I hereby give consent to the company to make enquiries about my credit record with any agency and to obtain whatever information they might require to process the application, I also give consent to the company to share my payments behaviour with any agency. I also declare that all of the above information is true and correct.

Blacklisted Car Finance Application Form

Personal Details

Employment Details

Banking Details

Income Breakdown