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Application Form

Personal information

ID Number: Marital Status:  Single Married Divorced Widow
First Name: Surname:
No. of Dependants: Spouse Name:

Residential Address

Province: Home Tel:
City: Cellphone:
Suburb: Email Address:

Employment Information:

Employer: Start Date:
Occupation: Employee No:
Tel (w): Fax:
Tel (HR): Work Email:

Income Details

Work Address

Salary Date: Address:
Net Income after deductions: Province:
Frequency City:
Is the salary paid to bank? Suburb:
Are you currently under Debt Review, Debt Counselling or under Administration?    Yes No

Information: Spouse

Is your spouse employed?    Yes No
Cellphone: Tel(W):
Employer: Occupation:

Relative 1

Relative 2

Name: Name:
Surname: Surname:
Relationship: Relationship:
Contact No: Contact No:
 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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