Please make sure to complete as much information as possible as this may influence the outcome of your application.

Model
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Good Description
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Make
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Dealer Supplier
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Type
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Finance Terms
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Residual
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Cash Price
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Deposit/Trade-in
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Personal Details

Title
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Name
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Surname
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ID NO.
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Gender
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Marital status
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Date Married
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Home Address
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Period living at the above address
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Contact Number (Work)
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Cell Number
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Email Address
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Postal Address
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Next of Kin Name: (not living at the same address as yourself)
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Next of Kin Surname:
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Relationship
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Next of Kin Address
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Next of Kin Contact Number
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Bond Details

Bond Holder
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Amount Outstanding
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Property Value
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Installment
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Purchase Price
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Registered
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Renting
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Employer Details

Employer
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Occupation
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Employer Address
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Employer Contact Number
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Duration
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Bank Details

Bank Name
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Branch Name
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Branch Code
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Ethnic Group
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Language Preference
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Personal Application

Basic Monthly (Excl Car Allowance)
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Car Allowance

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Total Salary (Basic & Car Allowance)

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Monthly Commission

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Net Take Home Pay

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Income Other Than Salary/Wages

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Sources of Other Income

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Total Monthly Household Income (Net Salary & Other)
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Household Expenses Per Month

Bond Payments/Rent
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Vehicle Installments (Excluding Those To Be Settled)
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Credit Card Repayments
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Clothing Accounts
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Policy / Insurance Repayments
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Transport Costs
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Education Costs
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Rates, Water and Electricity
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Personal Loan Repayments
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Furniture Accounts
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Overdraft Repayments
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Telephone Payments
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Food and Entertainment
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Maintenance
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Other
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Total Monthly Household Expense
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Household Surplus / Disposal Income
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Are You Currently Liable as
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I confirm that:
  1. I am not a minor.
  2. I have never bene declared mentally unfit by a court.
  3. I am not subjected to an administrative order.
  4. I do not have any current application pending for debt restructuring or alleviation.
  5. I do not have any current debt re-arrangement in existence.
  6. I have not previously applied for a debt re-arrangement.
  7. I am not under sequestration.
  8. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.
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Declaration by client:
I hereby grant the Credit Provider the right to communicate with me through any electronic/written media or verbally in order to make available to me, their product offering.
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I hereby grant the Credit Provider the right to increase my Credit Limit once every yar to accommodate any Value Added Products needed and requested by me.
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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 application. I also give consent to the Credit Provider to share my payment behaviour with any credit agency.
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Get In Touch

102 Oceanview Drive, Blue Horizon Bay, Port Elizabeth.

041 776 1053

064 755 9820

anette@omaraconsulting.co.za

Registered Financial Services Provider: FSP 47735