PERSONAL INFORMATION


Full names and Surname:
Email Address:
Identity Number:
Physical Address:
 
Postal Code:

Postal Address:

 

Postal Code:

Telephone (Work)

Telephone (Home)

Cell Phone Number
Name of Employer (Company name)

Address of Employer (Company address)

Gross Salary:

R
DEDUCTIONS:  
Tax: R

Medical Aid:

R

Pension:

R

UIF

R
Other deductions: (please specify)  
R
R
R
R
R
R
R




DEPENDANTS


Name and Surname Age Male / Female Relationship – ie, child




Please note that if you are married IN community of property both you and your spouse has to go under Administration.


INFORMATION OF SPOUSE


Are you married?  NO YES IN community of property OUT of community of property
Full names of Spouse:
Identity Number:
Physical Address:
 
Postal Code:

Postal Address:

 

Postal Code:

Telephone (Work)

Telephone (Home)

Cell Phone Number
Name of Employer (Company name)

Address of Employer (Company address)

Gross Salary:

R
DEDUCTIONS:  
Tax: R

Medical Aid:

R

Pension:

R

UIF

R
Other deductions: (please specify)  
R
R
R
R
R
R
R
   
Do you own a house?
Is your house paid for in full?
Do you own a car?
Is your car paid for in full?
   
Do you have anything on Hire Purchase? (ie: furniture that you are still paying off)



If yes, please specify:



CREDITOR: PRODUCT: MONTLY INSTALMENT:
R
R
R
R
R
R
R
R
R




COMBINED MONTLY COMMITMENTS OF YOU AND YOUR SPOUSE IF MARRIED



This includes all monthly commitments other than outstanding Debt ( ie. School fees, traveling costs, medical expenses, etc.)

Commitment: Monthly Expense:
Rent R
Water and Electricity R
School Fees R
Transport R
Cellphone contract R
Medical Aid (if not deducted from payslip) R
Pension (if not deducted from payslip) R
Maintenance for children not living with you R
Groceries R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
TOTAL: R




DEBT OBLIGATIONS



(Please provide copies of latest statements for all your balances due. If you are married in community of property please include all debt obligations of your spouse as well)

Debt Commitment
(ie: personal loan)
Name of Creditor Total Amount Outstanding
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
TOTAL:   R