Application for Instalment Finance Application for Instalment Finance

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					                                                                                                                                                                                                               Application for Instalment Finance
                                                                                                                                                                                              F&I or BDO Name                                                         WesBank Account Number

                                                                                                                                                                                              F&I or BDO Fax Number

Transaction details                                                                                                       Where applicable place                 3                               Financial details
Goods Description                                                                                                                        M&M Code
                                                                                                                                                                                                                                         Cash Price (Incl. VAT)
                                                                                                                                                                                                  All Dealer                                                            = R
Dealer Name                                                                                                                    Contat                                                             Extras (Incl. VAT)

Dealer Code                                                  Dealer Classification %                                 Dealer Telephone Code (                            )
                                                                                                                     and Number                                                                                                      R

A        Instalment                                                                                                NACM
                                         WheelSave Plus Account
         Sale                                                                                                      Rate     = Prime +              %                                                                                 R                                 + R
B        Suspensive
         Sale                                                                                                      Payment                                                                        All Bank
F        Lease -                                                                                                   frequency        M Q A                                                         Extras (Incl. VAT)
         Inside CAA                                                                                                                                    Arrears
G        Lease -                         Purpose for which                                                         First
         Outside CAA                     Goods required                                                            Payment                             Fixed                                                                         R
I        Rental -                                                                                                  Date                              Linked
                                                              Business                                                                                                                                                               R
         Inside                                                                                                    Period of                 Special Requirements
                                                              Private                                              Contract                                                                                                          R                                 + R
O   Rental -
    Outside                                                   Taxi                                                 (Months)
Proposed Monthly Instalment                                                  PIC                                   Balloon                                                                                                               Deposit                       - R
                                                                                                                   Payment or
R                                                                                                                  Residual                      %      R
Affordability                                                      Equity                                                                   Retail Price
                                                                                                                                                                                                                                               Amount to be
                                                  %                                                                        %                R                                                     Deposit                                      financed               = R
Personal details                                                                                                                                                                                                                                    Contact details
Title                         Surname                                                                                                                Identity Number                                                                                Business Telephone Code (            )
                                                                                                                                                                                                                                                    and Number

First Names                                                                                                                                                                                                 Ethnic Group                 Eng        Home Telephone Code (            )
                                                                                                                                                                                                                                                    and Number
Home Address                                                                                                                                                                        Years Months                       Postal Address               Cellular Phone Number

                                                                                                                                                                                                                                                    E-Mail Address
                                                                                                                                                Postal Code
Previous Home Address                                                                                                                                                                Years Months                                                   Income details
                                                                                                                                                                                                                                                    Basic Salary per month

Employment details                                                                                                                                                                                                                                  R
Employer’s Name & Address                                                                                                                                                                              Type of Industry                             Car Allowance per month

                                                                                                                                                                                                                                                    Commission per month
                                                                                                                                                                                                       Employee Number

                                                                                                                                                                                                                                                    Other Income per month
                                                                                                                                                                            Years             Months Occupation

Previous Employer’s Name & Address                                                                                                                                                                                           Years       Months     Total Income per month

Spouse’s details                                                                                                                                                                                                                                    Marital details
Spouse’s Name                                                                                                                           Spouse’s Salary per month                              Spouse’s I.D. No/Date of Birth                       Single    Divorced        Widowed        Separated

                                                                                                                                        R                                                                                                           Date Married         ANC       COP       Other
Spouse’s Employer’s Name & Address                                                                                                                                    Spouse’s Occupation                                  Years   Months

                                                                                                                                                                                                                                                    No. of dependant children

Relative’s details                                                                                                                                                                                                                 Landlord’s details
Name & Address of Nearest Relative in South Africa not living with you                                                                          Relationship             Relative’s Telephone Code (                   )           Name & Address of Landlord where goods will be kept
                                                                                                                                                                         and Number

Existing and/or previous accounts with WesBank and/or other Credit Institutions
Name of Company                                                                                                           Branch                                            Account Number                     Instalment/month                No. Paid        Current Paid Up/To be Settled

Home Ownership details                                                                                                                                                                          Banker’s details
 Do you own your own home?                                            In Your                In Your                  Bond or Rent Repayment per month                                          Credit Card Company                               Credit Card Number
                                                                      name                   spouse’s
Yes                                   No                                                     name                     R
Stand No.                            Suburb                                                                                        Bondholder Name & Branch                                     Cheque      Savings         Transmission        Account No.

Purchase Price                                                                       Date of Purchase                                                                                           Branch Name and Code
Current Value                                                              Current Bond                                                                                                         Bank Name                                         Name of Account Holder
R                                                                          R
Vehicle Insurance YES (Existing Policy)                                                                                                                                                                         Vehicle Insurance NO (No Existing Policy)
 Existing Insurance Company Name                                                        Telephone Code & Number                              Policy Number                                                  Cover Required                 Customer to Arrange

                                                                                                                                                                                                               Yes            No           Cover Note Number

 Broker Name                                                                            Telephone Code & Number                              Inception Date                     Monthly           Annual    NCB        Insured Value                          Cash       Monthly     Annual
                                                                                                                                                                                                                                                                                     Taxi Only
Certified true and correct - Signature of Applicant                                                                                                  Date                                               Prepared by                                           Guarantor’s Name

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Item No.        12010.7 (7/99)

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