` Application Form
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Application Form

Personal information


Residential Address

Employment Information:

Income Details

Work Address


Are you currently under Debt Review, Debt Counselling or under Administration?    Yes No

Information: Spouse

Is your spouse employed?    Yes No

Relative 1

Relative 2

 I declare the information on this form to be true and correct and hereby give consent to African Advantage to perform a credit
        check when assessing my application

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