Imperial Toyota Bedfordview
Application Form FSP
Email: mjdesousa@motustoyota.co.za
NEW
GOODS DESCRIPTION YEAR MODEL MAKE M&M CODE
USED
DEALER: Imperial Toyota Bedfordview TEL NO: 011 372 4800
Business Manager: Sabelo Gumede SALES PERSON: Mario Junior De Sousa FAX NO:
CASH PRICE VAT INCL. R VATABLE EXTRAS VAT INCL. INSTALMENT LEASE CONSUMER LEASE
SERVICE & DELIVERY R R TERM/PERIOD
R R RATE-LINKED
R R Residual %
R Deposit R OTHER
PRINCIPLE DEBT R
PERSONAL DETAILS TITLE SURNAME ID No.
FULL NAMES INITIALS DEPENDANTS
MALE FEMALE MARRIED ANC COP SINGLE WIDOWED DIVORCED
Date of marriage
HOME ADDRESS PERIOD
TEL(H) TEL(W) CELL FAX E-MAIL
POSTAL ADDRESS CODE
PREVIOUS ADDRESS PERIOD
SPOUSE NAMES SPOUSE ID
FULL NAME OF NEAREST RELATIONSHIP
RELATIVE
ADDRESS TEL
BOND DETAILS BANK AMOUNT OUTSTANDING R
PROPERTY VALUE INSTALMENT R PURCHASE PRICE R
DATE PURCHASED REGISTERED OWN NAME SPOUSE RENTING BOARDING R
EMPLOYER DETAILS OCCUPATION
EMPLOYER; TEL YRS MTS
EMPLOYER ADDRESS PERIOD
SALARY DATE PREVIOUS EMPLOYER PERIOD
SPOUSE EMPLOYER PERIOD
TEL OCCUPATION
BANKING DETAILS - APPLICANT
BANK NAME BRANCH NAME BRANCH CODE
NAME OF ACCOUNT HOLDER ACCOUNT NO.
CREDIT CARD SAVINGS TRANSMISSION CURRENT
PREVIOUS VA BRANCH ACCOUNT No. INSTALMENTS PAID UP / CURRENT / TO BE SETTLED
FINANCE
LANGUAGE PREFERENCE ENGLISH (PRIMARY) AFRIKAANS (FOR AN EXPLANATORY VERSION)
Signature _________________________________________________________ Date ____________________________
APPLICANT INITIALS: SURNAME:
ID NUMBER:
MONTHLYINCOME DETAILS – APPLICANT (PER MONTH)
BASIC SALARY R OTHER HOUSEHOLD INCOME:
CAR ALLOWANCE R R
MONTHLY COMMISSION R R
INCOME OTHER THAN SALARY/WAGES R R
NETT INCOME R TOTAL MONTHLY HOUSEHOLD INCOME (A) R
HOUSEHOLD’S EXPENSES PER MONTH:
BOND PAYMENT / RENT R RATES, WATER & ELECTRICITY R
VEHICLE INSTALMENTS (EXCLUDING THOSE TO BE SETTLED NOW) R PERSONAL LOAN REPAYMENTS R
CREDIT CARD REPAYMENTS R FURNITURE ACCOUNTS R
CLOTHING ACCOUNTS R OVERDRAFT REPAYMENTS R
POLICY / INSURANCE REPAYMENTS R TELEPHONE PAYMENT R
TRANSPORT COSTS R FOOD AND ENTERTAINMENT R
EDUCATION COSTS R MAINTENANCE R
HOUSEHOLD EXPENSES R OTHER REGULAR PAYMENTS / COSTS R
PROVIDE DETAILS
R
SUB TOTAL R TOTAL MONTHLY EXPENSES (B) R
Disposable Income
TOTAL HOUSEHOLD DISPOSABLE INCOME TOTAL INCOME (A) R ______________ - TOTAL EXPENSES (B) R R
______________
ARE YOU CURRENTLY LIABLE AS: SURETY CO-DEBTOR GUARANTOR
SPECIFY DETAILS OF DEBT:
IF YOU HAVE SIGNED SURETY OR CO-DEBTOR PLEASE INDICATE THE FULL AMOUNT OUTSTANDING ON THE ACCOUNT/S 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 under sequestration.
H. I do not have applications pending for credit, nor open quotations as envisaged in Section 92 of the National Credit Act.
I. The information provided by me in this application is true and correct.
If any of the above is incorrect give details: _________________________________________________________________________________________________________________
Declaration by client:
I hereby grant the Credit Provider the right:
i) to increase my Credit Limit once every year to accommodate any Value Added Products needed;
ii) to authorise the Credit Provider to make enquiries about my credit record with any credit agency;
iii) to obtain whatever information on me they might require to process this application.
I understand that I will be liable for a monthly service fee.
I also authorise the Credit Provider to share my payment behaviour with any credit agency and the National Loans Register.
Signature _________________________________________________________ Date ____________________________
