1976 Ford F100 Pick-up 5.0L V8

VEHICLE DETAILS

APPLICANT DETAILS

EMPLOYMENT DETAILS

BANKING DETAILS

SPOUSE DETAILS

RELATIVE NOT RESIDING WITH YOU

INCOME ON PAYSLIP

MONTHLY EXPENSES

I confirm that:
* I am not a minor
* I have never been declared mentally unfit by a court
* I am not subject to an administration order
* I do not have any current application pending for debt restructuring or alleviation
* I do not have any current debt re-arrangement in existance
* I have not previously applied for a debt re-arrangement
* I am not under sequestration
* I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act
If any of the above is incorrect give details:
I understand that I will be liable for a monthly service fee. I hereby consent to this Credit Provider making enquiries regarding my credit history with any credit bureau. I consent to this Credit provider the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider's obligation under the National Credit act.
I hereby declare that the information provided by me is true and correct
I hereby also give consent to electronically obtain account statements from financial institutions