Jakaranda Motors

– Finance Application Form – Jakaranda Motors

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Afrikaanse Weergawe -

– Personal Information –

Title:

Name:

Surname:

ID No:

Tel(W): Tel(H): Tel(C):

Email:

Residential Address:

Postal Address:

Previous Residential Address:

Postal code:

Duration at: Current address: Prev address:

– Employment Information –

Employer:

Type of Industry:

Physical address of employer:

Occupation:

Duration at current employer:

Employment No:

Current Salary: R

Car Allowance: R

Total Income/Month: R

Other income: R

telephone number of employer:

Previous employer:

– Reference –

Name of relative not liveing in the house:

Relationship:

Physical address of said relative:

Tel(W): Tel(H): Tel(C):

– Home Ownership Details –

Do you have your own home? Yes No

Is it in your name? Yes No

– Spouse's Information –

Marital Status:

Spouse's Name:

ID No:

Date of marriage:

Occupation:

If employed, name of employer:

Salary:

Physical address of employer:

Tel(W): Tel(C):

– Vehicle you are interested in –

Model:

Year: Colour:

Dealer:

Vehicle Price: R

Deposit/Trade In: R

– Bank Detail –

Name of bank:

Account Type:

Account No:

Branch:

Branch Code:

Do you have a Credit Card? Yes No

If Yes, with which bank:

Credit Card No:

Type of Card:

– Vehicle Finance –

Do you have vehicle finance? Yes No

With who ?

Please Complete, Print and Fax back to us: Gezina (012) 335-1726 - Centurion (012) 663-2971