YOUR PERSONAL DETAILS YOUR SALARY BANK DETAILS - …

1 your LOANM arital Status:Employment:Education:Ethnic Group:Contract:Residence:Preferred method of correspondence in terms of Section 129 of the National Credit Act of 2005:How do you wish to receive your account statement?Frequency:MARRIEDFULL TIMEHIGH SCHOOLDIVORCEDPART TIMEUNIVERSITYNO CONTRACTBONDE-MAILWIDOWEDTEMPCOLLEGEBLAC KCONTRACTRENTINGEMAILFAXPOSTMONTHLYGOVER NMENTSAVINGSWEEKLYCASHPTY (LTD)QUARTERLYOTHERMZANSIFORTNIGHTLYCHEQ UECCCHEQUEMONTHLYEFT/TRANSFERSINGLEUNEMP LOYEDTECHNIKONWHITEANCHOME OWNERLIVE TOGETHERSELF EMPLOYEDOTHERCOLOUREDCOPBOARDERPOSTAGESE PARATEDCONTRACTNONEASIANTRADITIONALHOSTE LLIVE WITH PARENTSYOUR PERSONAL DETAILSMrMYYCCCCYYYYMMMMDDDDMo Tu We ThFrSa SuDDYYYMEXTMMMMsDebit OrderPayrollEmployer:GenderFNMrsFirst Name:First Name:First Name:Postal Address:E-mail Address:Physical Address:Physical Address:Physical Address:Employer:Workplace:HR Contact Person:Supervisor:Previous Physical Address:Workplace Physical Address:Other Pay Rules.

2 Other Names:Suburb:Suburb:Suburb:Suburb:Suburb :Suburb:Telephone (Home):Telephone (Home):Telephone (Home):Agent / Consultant Code:Telephone (Work):Telephone (Work):Telephone:Telephone (Workplace):Surname:ID Number:ID Number:Province:Province:Province:Employ ee Number: bank Name:Pay Date (Monthly):Account Number: SALARY Frequency:Payment Method:Account Type:Employment Start Date:Retirement Age:Contract End Date:Occupation:Province:Province:Provin ce:Preferred Language:Number of dependants:(numbers only)Second Name:Employer Code:Surname:Surname:Maiden Name:Town/City:Town/City:Town/City:Town/ City:Town/City:Town/City:Cellular Number:Cellular Number:Cellular Number:Branch Code:ID Number:Relationship:Relationship:Code:Co de:Code:Department:Branch Name:Pay Day (Weekly/Fortnightly):Code:How long at this address?

3 How long at this address?Home Language:Are you under or have you applied for Administration or debt review? your CONTACT DETAILSYOUR WORK DETAILS (Chosen domicilium citandi et executandi) your SALARY bank DETAILSNEXT OF KIN/SPOUSE DETAILSOTHER RELATION(NOT LIVING WITH YOU)Bruma Finance (PTY) LtdCALL CENTRE HELPDESK: 0861 33 11 33 Reg. No. 2006/005672/07 NCR Reg. No. NCRCP408 VAT No. Box 46059, Orange Grove, 211971, 4 Street, Houghton Estate, Johannesburg, 2198 Tel: (011) 359-7000 Fax: (011) 483-3310thI declare that the above information is both true and correct and that, together with other information, this will be used to determine whether I can afford the deduction ofthe loan applied for. This loan application is subject to final approval and may be accepte d or rejected by Bruma Finance (Pty) Ltd in its sole and absolute hereby authorise and consent Bruma Finance (Pty) Ltd making enquiries about my Credit Record with any Credit Reference agency and any other third party to verifyany or all of the information provided by me.

4 I further consent to Bruma Finance (Pty) Ltd carrying out identity and fraud prevention checks and sharinginformationrelating to this application through the South African Fraud Prevention Service. I have read and understood the attached terms and conditions and considered myselfbound by them should I enter into a loan aggrement with Bruma Finance (Pty) :Telephone:Signed at:Agent / Consultant:Client Name:Client Signature:Reason for loan:Type:How did you find us?FUNERALDEBTSHOUSINGBUSINESSEDUCATIONF URNITUREOTHERAGENTFRIENDNEWSPAPERPOSTER /PAMPHLETDIRECT MAILINTERNETOTHERV6 30/04/2008 MONTHLY INCOMES AND EXPENSES DECLARATIONPAYSLIP DETAILEXPENSES - CURRENT OR ANTICIPATED(NOT DEDUCTED ON PAYSLIP)Gross SALARY (as per payslip)Transport costsOvertime and commissionsFood / GroceriesCourt orders (includes garnishee and maintenance deductions)School feesNet SALARY (as per payslip)Telephone (home and cell)Insurance (Life and Short Term)Spouse income (separate to clients income)Clothing (not on account)Maintenance / Court order from spouse (as per bank statement)Rates and Taxes / Lights and WaterSavingsOther income (as per bank statement) - Specify.

5 Maintenance / Court order to spouse (not on payslip deductions)Other expensesOTHER MONTHLY INCOMER ental (housing)Medical feesRRRRRRRRRRRRRRRRRRR----------------- --Do you require the upfront initiation fee to be financed with the principal debt?Do you require Credit Life Insurance offered by Bruma Finance (Pty) Ltd (as per section 44 of the Long-TermInsurance Act, as reflected in your MLA and Terms and Conditions)?Do you consent to being marketed at your workplace?Telemarketing campaigns conducted by or on behalf of Bruma:Marketing or customer list that may be sold or distributed by Bruma:Any mass distribution of e-mail or sms messages:YYYYYYNNNNNNPLEASE INDICATE IF YOU REQUIRE BEING INCLUDED IN THE FOLLOWING:I declare that the above information is both true and correct and that, together with other information, this will be used to determine whether I can afford the deduction ofthe loan applied for.

6 This loan application is subject to final approval and may be accepte d or rejected by Bruma Finance (Pty) Ltd in its sole and absolute hereby authorise and consent Bruma Finance (Pty) Ltd making enquiries about my Credit Record with any Credit Reference agency and any other third party to verifyany or all of the information provided by me. I further consent to Bruma Finance (Pty) Ltd carrying out identity and fraud prevention checks and sharinginformationrelating to this application through the South African Fraud Prevention :Signed at:Client Name:Client Signature:Client Name:Client ID Number:Client Surname:(ALL CURRENT OR ANTICIPATED HOME LOANS, PERSONAL LOANS, OTHER LOANS, FURNITURE, CLOTHING OR ANY OTHER MONTHLY DEBTOBLIGATIONS. ALL bank STATEMENT DEDUCTIONS MUST BE DISCLOSED.)

7 SETTLEMENT LETTERS COMPULSORY FOR DEBT CONSOLIDATION)FINANCIAL DEBT OBLIGATIONSC ompany NameInstallment AmountSettlement AmountConsolidate DebtRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR-- --------------------------------YYYYYYYY YYYYYYYYYNNNNNNNNNNNNNNNNNB ruma Finance (PTY) LtdCALL CENTRE HELPDESK: 0861 33 11 33 Reg. No. 2006/005672/07 NCR Reg. No. NCRCP408 VAT No. Box 46059, Orange Grove, 211971, 4 Street, Houghton Estate, Johannesburg, 2198 Tel: (011) 359-7000 Fax: (011) 483-3310th