Personal Details

Employment Details

Spouse's Details

Relative's Details

Home Ownership

Banking Details

Existing and/or a previous account with this credit provider

Existing accounts with other credit providers

Landlord's details (where the goods will be kept)

Income Details

Total household expenses

Insurance-Bank VAPS Instalment Sale / Lease Inside the NCA

Insurance-Bank VAPS Instalment Sale / Lease Inside the NCA

Comprehensive Vehicle Insurance

Transaction Details

Know your customer

I confirm that:
(a) I am not a minor
(b) A court has never declared me mentally unfit.
(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 quotation as envisaged in section 92 of the national act.

If any of the above is incorrect, state which and give detail

I understand that I will be liable for monthly service fees
I hereby consent to this Credit Provider making enquiries regarding my credit history with any credit bureau.
I consent to this Credit Provider reporting the conclusion of any credit agreement with me to the national loans register in compliance with Credit Provider's obligation under the National Credit Act/.
I hereby declare that the information provided by me is true and correct.

Product suitability consent
I agree that the FirstRand Group may get and use my information from:
1. Credit bureaus, such as TransUnion
2. Third-party qualification data providers, that use information from universities and other educational institutions
To determine my eligibility for this application and if the solution being applied for is right for me – whether it is for transact, telecommunication, invest, rental and/or other
value added solutions. I agree that the Group may get, use and share my information with The South African Fraud Prevention Services. To detect, prevent and prosecute financial crime or if the Group reasonably believes that I have given false or misleading information or documents.You can manage your consent at any time through “My Profile” on the app. Your consent is important to proceed with your application. Without it, we won’t be able to process your application. If you withdraw your consent it will impact the ongoing use of the solution. For more information about the FirstRand Group, our solutions and your privacy, go to the Privacy Notice on our website.

In the last 6 months, have you received an S189 Retrenchment Notification
I understand that I will be liable for a monthly service fee.
I hereby consent to the Credit Provider making inquiries regarding my credit history with any credit bureau and I I hereby consent to the Credit Provider to make my personal information available for alternative finance options via Cash Power in compliance with this Credit Provider's obligation under the National Credit Act.
I hereby consent to the Credit Provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider's obligation under the National Credit Act.
By accepting this document, you confirm that you have read, understand and accept the provisions set out herein.