Application Form

Personal information

ID Number:
First Name:
Surname:

Marital Status:SingleMarriedDivorcedWidow

No. of Dependants:

Spouse Name:

Residential Address

Address:

Province:
City:
Suburb:

Home Tel:
Cellphone:
Email Address:

Employment Information:

Employer:
Occupation:
Tel (w):
Tel (HR):

Start Date:

Employee No:
Fax:
Work Email:

Income Details

Salary Date:
Net Income after deductions:
Frequency
Is the salary paid to bank?
Monthly Living Expenses:

Work Address

Address:
Province:
City
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

Name:
Surname:
Relationship:
Contact No:

Relative 2

Name:
Surname:
Relationship:
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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