You can fill in the online form below and we will submit your application for approval promptly.

Should you feel it is more secure to do so, feel free to download the printable form, fill it in and fax it back to us at:


We need:

  • Valid Drivers Licence copy
  • RSA Barcoded ID copy
  • Proof of physical address – water/lights account
  • Completed e-application
  • Latest proof of income e.g. payslip

Download our Printable Finance Form  

Personal Details:

Title Surname ID no
Full Names Initials Dependants  

Gender Marrital Status Date Married

Tel (H) Tel (W)
Fax E-mail
Cell No    
Home Address Period
Postal Address Code
Previous Address Period
Spouse Names Spouse ID
Next of Kin Relationship
Next of Kin Address Tel

Bond Details:

Bond Holder Outstanding
Date Purchased Registered

Rent Per Month

Employer Status:

Employer Occupation No. of Years
Employer Address Tel No. of Years
Salary Date Previous Employer No. of Years
Spouse Employer Occupation No. of Years

Bank Details:

Bank Name Branch Name Branch Code
Name of Account Holder Account No.  

Type of Account:

Trade References:

Branch Account No. Installments Paid Up/Current / To be settled



Personal Application

Details: Own Spouse
Salary Details R R
Basic Monthly ( Allowance) R R
Car Allowance R R
Total Salary (Basic & Car Allowance) R R
Monthly Commission R R
Net Take Home Pay R R
Income other than Salary / Wages** R R
Sources of other Income** R
Total Monthly Household Income
(Net Salary & Other)

Household Expences Per Month

Bond Repayment / Rent R Rates, Water & Electricity R
Vehicle Instalment
(Excluding those to be settled)
R Personal Loan Repayments R
Credit Card Repayments R Furniture Accounts R
Clothing Accounts R Overdraft Repayments R
Policy / Insurance repayments R Telephone Repayment R
Transport costs R Food & Entertainment R
Education Costs R Maintenance R
Household Expenses R Other R
Total Monthly Household Expenses R Household Surplus / Disposable Income R

Are you Currently Liable as: Amount R Specify Details:

If you have signed Surity or Co-Debtor, Please indicate the full amount Outstanding R

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 unde sequestration.

H. I do not have applications pending for credit,
nor open quotations as envisaged in section 92 of the National Credit Act.
I. If any of the above is incorrect, give details:

I Agree to the above

Decleration by Client

I hereby grant the Credit Provider the right to communicate with me throught any electronic/written media or verbally in order to make available to me, their product offering
I hereby grant the Credit Provider the right to increase my Credit Limit once every year to accommodate ant Value Added Products needed and requested by me.
I hereby give consent to the Credit Provider to make enquiries about my credit record with anty 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 behaviour with any credit agency.