Apply Online – Midcity Motors 2

Name

This field is for validation purposes and should be left unchanged.

Personal Details

Title

Full Names*

Surname*

ID Number*

Telephone (Home)

Telephone (Work)

Cellphone No.*

Email

Preferred methods of Communication

All

Email

Post

Telephone

SMS

Dependants

Gender

Relationship Status

Date Married

Language Preference

English

Afrikaans

Other

Ethnic Group

African

Coloured

Indian

White

Spouse Names

Spouse ID Number

Next of Kin

Relationship

Tel

Address Details

Property Type

Home Address*

Street Address City Province Period at Address

Postal Address (If different from home address)

Street Address Address Line 2 City Province Postal Code

Previous Home Address

Street Address City Province Period at Previous Address

Bond Details

Bond Holder

Purchase Price

Amount Outstanding

Property Value

Instalment per Month

Date Purchased

Rental Details

Landlord Name

Landlord Tel

Rent Amount per Month

Employer Details

Employer*

Occupation

Employer Address

Employer Telephone No.

Salary Date

No. of Years

Previous Employer

No. of Years

Spouse Employer

Occupation

No. of Years

Bank Details

Name of Account Holder

Bank Name

Branch Name

Branch Code

Account No.

Account Type

Income Details

Basic Monthly (Excl. Car Allowance)

Car Allowance

Monthly Commission

Net Take Home

Other Income

Source of Other Income

Other Income

Source of Other Income

Total Monthly Household Income (Net Salary + Other)

Household Expenses per Month

Bond Payment / Rent

Rates, Water & Electricity

Vehicle Installments

Personal Loan Repayments

Credit Card Repayments

Furniture Repayments

Clothing Accounts

Overdraft Repayments

Policies / Insurance

Telephone Payment

Transport Costs

Food & Entertainment

Education Costs

Maintenance

Household Expenses

Other Expenses

Total Monthly Household Expenses

Household Surplus / Disposable Income

Are you currently liable for any of the following?

Surety

Guarantor

Co-Debtor

Specify Details of Liability

If you have signed surety or co-debtor, please indicate outstanding amount

Submit Documents

Copy of Drivers Licence

Copy of RSA Barcoded ID or New ID Card

Proof of Residence (account in applicants name)

Proof of Income (Payslip)

Submit Documents

Drop files here or

Max. file size: 64 MB.

Please only upload jpg, gif, png or pdf formats

Confirmation

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.

If any of the above is incorrect, please give details:

I hereby grant the Credit Provider the right to communicate with me through any electronic/written media of verbally in order to make available to me, their product offering.

Yes

No

I hereby give consent to the Credit Provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the credit application and / or application for insurance. I also give consent to the Credit Provider to share my payment behaviour with any credit agency.

Yes

No

I hereby declare that all the information submitted is true and correct.

Yes

No

CAPTCHA

ONLINE APPLICATION FORM

Personal Details

Address Details

Bond Details

Rental Details

Employer Details

Previous Employer

Spouse Employer

Bank Details

Income Details

Household Expenses per Month

Submit Documents

Confirmation