Consultants : Contact our Specialist Consultant on:

iDebtAssist Tel: 072 325 5790

PAUL : 072 325 5790 Fax: 086 694 7553

Purpose of application: Monthly Expenses

New Loan Advance on existing loan Amount R Type / Service Amount
Personal details (Applicant): Personal details (Co-Applicant): Bond / rental R
Surname Surname Lease Agree R
Name Name Credit card R
ID No ID No Insurance R
Tel (W) Tel (W) Fuel / Travel R
Fax No Fax No. Education R
Cell Cell Loan Payments R
Dependants Ethnic Period at current address Yrs Mnths Electricity / Water R
Physical address Groceries R
Postal address Postal code Clothing R
Marital status (√) Single Married ANC COP Divorced Medical Accounts R
Employment / Salary Details (Applicant) Employment / Salary Details (Co-Applicant/Surety) Telephone R
Employer Employer Domestic Wages R
Occupation Occupation Alimony R
Employer Address Employer Address TV / M-Net / DSTV R
Employment period Employment period Entertainment R
Basic Salary R Basic Salary R Donations R
Average Overtime R Average Overtime R Other (Specify) R
Other source of income R Other source of income R 1. R
Highest qualification Highest qualification 2. R
Income Tax nr: Income Tax nr: 3. R
List of Existing Accounts (Applicant) List of Existing Accounts (Co-applicant/Surety) 4. R
Institution Type Account number Institution Type Account number Total expenses R
Bond Bond ! Kindly supply the following!
Cheque Cheque Copy of ID/s of the participants
Credit 3 Most recent salary advice
Credit Card 3 Months Bank statements
Card
Savings Savings 6 Months Bond statements
Vehicle Vehicle Title Deed (if applicable)
Marriage certificate
Security (Fixed property details)
• If married in C.O.P. forward both
Stand No. Sub / Ext City parties details & documents
Physical Address • Water and Lights account
Postal Address Code
Bank Name Purchase Date Bond Acc No • OWN BUSSINESS (if applicable)
Market value R Purchase Price R • 6 Months Bank Statements
• Financial Statements for the last
Loan Amount Required R Square m² year
Mark: Instalment to be paid: Direct Debit ________ Salary Stop Order ________ • Auditor’s letter
Assets Liabilities *Please note that both the
Fixed properties (Total) Fixed properties (Total) applicant’s and the co-applicant /
surety’s salary slip, bank and bond
1. R 1. R statements must be submitted.
2. R 2. R
I/we declare that the foregoing information is
Vehicles (Make/Model) Vehicles (Make/Model) correct. I/we consent to idebtassist making
1. R 1. R credit enquiries in order to consider this
application, and to make available details
2. R 2. R regarding the management of my / our
account/s to credit reference agencies.
Furniture / Household R Furniture / Household R I we give permission to idebtassist for
Life Insurance Policies R Outstanding Bonds R obtaining information on my / our insurance
portfolio in order to assist me / us with my
Investments R Bank loans R financial planning.
Credit (All Accounts) R Credit Cards R
Other (Specify) R Other (Specify) R ______________________________
R R Applicant Date

Total Assets R Total Liabilities R _______________________________

Co-Applicant Date
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