Download Printable application form: Click Here and email to firstname.lastname@example.org OR apply online here Please confirm the following before we can proceed. If you are under debt review, we will not able to assist you, according to the national credit act. Please note that "DEBT REVIEW" is not the same as "BLACKLISTED"!Debt Review | I hereby confirm the following:* I am not under Debt Review I earn more than R8500 p/m I have a drivers licenseYESNOPersonal Detail. Rest assured that your personal info will be kept highly confidentialFull Names & Surname* First Middle Surname Phone*Email* ID Number*Gender*MaleFemaleAre you married*YesNoDivorcedIf yes, how many year?E.g 4 yearsAddress* Street Address Address Line 2 City ZIP / Postal Code Term at pressent address*E.g 4 yearsType of residency*BondedBond freeTenantNext of Kin Name (Not living with you)* First Last Phone*Address* Street Address Address Line 2 City ZIP / Postal Code Bank Name*Account number*Account Type*ChequeSavingsEmployment Type*EmployedSelf-EmployedVehicle Registration*Personal NameBusiness NameCompany Name*Company Registration NumberEmployer Name*Job title*How many years at current job?* Date Format: YYYY dash MM dash DD Work Phone*Address* Street Address Address Line 2 City ZIP / Postal Code Gross income (Including ALL overtime, allowances and commissions)*Nett income (Including ALL overtime, allowances and commissions)*Other income for expample Rent etc.Please specifyBond or Rent*Water and Electricity*Vehicle installment/s*Are you trading in this/these vehicle/s*YesNoPersonal loan installment/s*Credit cards installment/s*Furniture installment/s*Clothing acc installment/s*Policies & Insurance*Telephone costs*Transport costs*Education costs*IDAccepted file types: jpg, gif, png, pdf.Paylslip (Latest 3 months)Accepted file types: jpg, gif, png, pdf.Bank statement (Latest 3 months)Accepted file types: jpg, gif, png, pdf.Divers LicenseAccepted file types: jpg, gif, png, pdf.Proof of residenceAccepted file types: jpg, gif, png, pdf.Consent* Credit Provider ConsentI, the undersigned hereby authorize Blacklisted Vehicle Finance to obtain a Credit Bureau report in my name, via LUCID Legal Business Services (Pty) Ltd with registration number 2003/016694/07. I understand that Blacklisted Vehicle Finance will apply at multiple Financial Institutions, including but not limited to Normal Banking Groups in South Africa.Consent* AcknowledgementI hereby confirm that the above info provided, is accurate and correct. This iframe contains the logic required to handle Ajax powered Gravity Forms.