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Download Printable application form: Click Here and email to info@blacklistedvehiclefinance.com

OR apply online here

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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

Personal Detail. Rest assured that your personal info will be kept highly confidential
Full Names & Surname*
First Middle Surname
Phone*
Email*
ID Number*
Gender*
- Male
- Female
Are you married*
- Yes
- No
- Divorced
If yes, how many year?
E.g 4 years

Address*
Street Address Address Line 2 City ZIP / Postal Code
Term at pressent address*
E.g 4 years
Type of residency*
- Bonded
- Bond free
- Tenant

Not living with you.
Next of Kin Name*
First Last
Phone*
Address*
Street Address Address Line 2 City ZIP / Postal Code

Bank Name*
Account number*
Account Type*
- Cheque
- Savings

Employment Type*
- Employed
- Self-Employed
Vehicle Registration*
- Personal Name
- Business Name
Company Name*
Company Registration Number
Employer 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 specify

Bond or Rent*
Water and Electricity*
Vehicle installment/s*
Are you trading in this/these vehicle/s*
- Yes
- No
Personal loan installment/s*
Credit cards installment/s*
Furniture installment/s*
Clothing acc installment/s*
Policies & Insurance*
Telephone costs*
Transport costs*
Education costs*

ID
Accepted 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 License
Accepted file types: jpg, gif, png, pdf.
Proof of residence
Accepted file types: jpg, gif, png, pdf.

Consent*
Credit Provider Consent
I, 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*
Acknowledgement
I hereby confirm that the above info provided, is accurate and correct.
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