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Personal Application Form

Household's Expenses Per Month:

1. I am not a minor.
2. I have never been declared mentally unfit by a court.
3. I am not subject to An administration order.
4. I do not have any current application pending for debt restructuring or Alleviation
5. I do not have any current debt re-arrangement existence.
6. I have not Previously Applied for a debt re-arrangement.
7. I am not under sequestration.
8. I do not have applications pending for credit, not open quotations as envisaged in section 92 of the national credit act.
   if any the above is incorrect give details :
   
9. I hereby grant the Credit Provider the right to communicate with me through any eletronic/written media or verbally in order to make a available to me, their product offering.
   
   YesNo

I hereby grant the Credit Provider the right to increase my Credit Limit once every year to accommodate any Value Added Product needed and request by me.

I hereby declare that all the above information is true and correct.