LOAN APPLICATION FORM - Global Finance

1 LOAN APPLICATION form . Plse complete and fax/email back to us with latest salary advice, 3 mnth bank statement, and a clear id copy PERSONAL LOAN: HOME IMPROVEMENT : FURNITURE Finance : CAR Finance : LOAN AMOUNT: Chain Details BROKER NAME AGENT NAME Merchant Code Personal Quick Check Details Title Language Ethnic Group Surname First Name Second name ID Number Home Tel Number Cellphone Number Work Tel Number Extension Marital Indicator Never Married Married Divorced Widowed EMAIL: How Married? Antenup Contract Comm of Property Single Tribal FAX: How many dependants do you have Are you under Administration, Sequestration, Liquidation or Debt Counselling? Yes No Address Details Residential Address Postal Address Line 2 Line 2. Suburb Suburb City City Postal Code Home Owner Renting Postal Code Employment Details Employment Status Perm Contract IF SALARY DATE FALLS ON WEEKEND OR Employer Date Employed public holiday when do do you get paid?

2 HR Contact Person Department Occupation HR Contact Number Salary Frequency M F W Salary Pay Date Employee Number Employers Adress Spouse Details Title Surname First Name Second Name Gender Male Female ID No Gross Salary R NB! Net Salary R Other Income R. Employer Name Work Tel: Cell Number: Income and Expenses only your own individual expenses Basic Salary Bond/Rent not on bank statement Bank Name: Overtime Rates, Water, Electricity Branch Name: Permanent Allowances Groceries Branch Code: Bonus Transoprt & Petrol Acc Type: Other Income Education and School Fees Acc No: Telephone - Cellphone Retail - Clothing - Furniture accounts Other Expenses Next of Kin not staying at same address than applicant Friend / Relative 1. Title Surname Firstname Relationship Work Number Home Number Cell Number Physical Adress Friend / Relative 2 Title Surname Firstname Relationship Work Number Home Number Cell Physical Address Acknowledgement, Consent and Authorisation by Applicant TO BE READ AND UNDERSTOOD BY THE Finance APPLICANT BEFORE SIGNING.

3 - Make any reasonable enquiries to confirm the details provided in this APPLICATION - Access the files of any credit bureau, third party or any other relevant database to obtain my credit records which may be relevant to this APPLICATION : Signature: Date.