stage - LisaCars

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

Your Details

First Names*

Surname*

Title*

Initials*

Gender

Female
Male

Date of Birth*

Day

Month

Year

Home Phone

Cell Phone*

Email*

Your ID number*

Marital Status*

Married
Divorced
Widow/er
Single

Marriage Contract

ANC
COP
CM
NA

Marriage Date

Day

Month

Year

Residential Information

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Type*

Period at Address (months)*

Postal Information

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employment Information

Employer Name / Company*

Employment Category*

Months at Employer*

Work Phone No.*

Employer's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Referred by / Salesperson*

Relative (next of kin) details

First Names*

Surname*

Your Relationship*

Phone Number*

Address

Address Line 2 City State / Province / Region ZIP / Postal Code

Your Banking Details

Account holder name*

Bank*

Account Number*

Branch Name*

Branch Code*

Account Type*

Financial Information

Household Income per month

Your Income*

Your salary day

Your Gross Salary*

Your monthly commission

Your car allowance

Other allowances

Bonus / Overtime Income

Your Net Take Home Pay*

Any Other Income

Your Spouse's Income

Spouse Monthly Commission

Spouse Car Allowance

Other Allowances

Spouse Bonus / Overtime Income

Spouse Net Take Home Pay

Spouse Other Income

Household Expenses per month

Your Monthly Bond / Rent

Your Monthly Rates

Your Monthly Expenses on Personal Loans

Your Monthly Credit Card Expenses

Your Monthly Transport Expenses

Your Monthly Telephone / Mobile Expenses

Your Food & Entertainment Expenses

Your Education Expenses

Your Policy Premiums

Your Overdraft Expenses

Your Maintenance Expenses

Your Household Expenses

Your Vehicle Expenses

Your Insurance Expenses

Your Security Expenses

Your Other Expenses

Spouse's Monthly Bond / Rent

Spouse's Monthly Rates

Spouse's Monthly Expenses on Personal Loans

Spouse's Monthly Credit Card Expenses

Spouse's Monthly Transport Expenses

Spouse's Monthly Telephone / Mobile Expenses

Spouse's Food & Entertainment Expenses

Spouse's Education Expenses

Spouse's Policy Premiums

Spouse's Overdraft Expenses

Spouse's Maintenance Expenses

Spouse's Household Expenses

Spouse's Vehicle Expenses

Spouse's Insurance Expenses

Spouse's Security Expenses

Spouse's Other Expenses

Please confirm the following*

You are not a minor
You have never been declared mentally unfit by a court
You are not subject to an administration order
You do not have any current debt re-arrangement
You have not previously applied for debt re-arrangement
You do not have applications pending for credit, nor do you have any open quotations under section 92 of the National Credit Act 34 of 2005 ("National Credit Act")
You are not currently in debt counselling
You hereby consent to a credit check
I consent to the Vehicle Finance Terms & Conditions

Deposit Amount

Your ID number*