Finance Application Form

From humble beginnings in 1976, Rally Motors has become a landmark dealership in Bloemfontein and boast over 100 vehicles in our 500 square meter premises.

    PERSONAL DETAILS:
    Title *

    Full Names *

    Last Name *

    Initials *

    ID Number

    Dependents *

    Sex *

    Marital Status *

    Date Married

    E-mail Address *

    Tel: (H)

    Tel: (W)

    Cell Number *

    Home Address *

    Period

    Postal Address

    Postal Code

    Previous Address

    Period

    Spouse Names

    Spouse ID

    Next of kin *

    Relationship

    Address of Kin *

    Contact Number *

    BOND DETAILS:
    Bond Holder

    Bank

    Outstanding Amount

    Date Purchased

    Registered Under

    Renting Amount

    EMPLOYER DETAILS:
    Employer *

    Occupation *

    Employer Address *

    Company Tel *

    No. of Years *

    Salary Date *

    Previous Employer

    No. of Years

    Spouse Employer

    Occupation

    Employer Address

    Company Tel

    No. of Years

    BANK DETAILS:
    Name of Account Holder *

    Account Type *

    Bank Name *

    Branch Name *

    Branch Code *

    TRADE REFERENCE:
    Branch

    Account Number

    Installments

    Paid / Current / Settled / To Be Settled

    Branch

    Account Number

    Installments

    Paid / Current / Settled / To Be Settled

    ETHNIC GROUP:
    Race *

    Language *

    PERSONAL APPLICATION:
    * Salary Details: (Own) R

    Salary Details: (Spouse) R

    * Basic Monthly (Excl. Car Allowance): (Own) R

    Basic Monthly (Excl. Car Allowance): (Spouse) R

    Car Allowance: (Own) R

    Car Allowance: (Spouse) R

    Total Salary (Basic + Car) (Own) R

    Total Salary (Basic + Car) (Spouse) R

    Monthly Commission (Own) R

    Monthly Commission (Spouse) R

    Net Take Home Pay (Own) R

    Net Take Home Pay (Spouse) R

    Income other than Salary/Wages ** (Own) R

    Income other than Salary/Wages ** (Spouse) R

    Sources of other Income ** (Own) R

    Sources of other Income ** (Spouse) R

    Total Monthly Household Income
    (Net Salary & Other) R

    HOUSEHOLD EXPENSES PER MONTH:
    Bond Repayment / Rent R

    Rates, Water & Electricity R

    Vehicle (Excluding those to be settled) R

    Personal Loan Repayments R

    Credit Card Repayments R

    Furniture Account Repayments R

    Clothing Account Repayments R

    Overdraft Account Repayments R

    Policy / Insurance repayments R

    Telephone Account Repayments R

    Transport cost Payments R

    Food & Entertainment Budget R

    Education Cost Payments R

    Maintenance & Repair Payments R

    Other Household Expenses R

    Other Expenses & Payments R

    Total Monthly Household Expenses R

    Household Surplus / Disposable Income R

    Are you currently Liable as:

    Specify Details

    If you have signed Surety or Co-Debtor, Please indicate the full amount Outstanding R

    I Confirm that:

    A. I am not a minor.
    B. I have never been declared mentally unfit by a court.
    C. I am not subject to an administration order.
    D. I do not have any current application pending for debt restructuring or alleviation.
    E. I do not have any current debt re-arrangement in existence.
    F. I have not previously applied for a debt re-arrangement.
    G. I am not under sequestration.
    H. I do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act.

    I. If any of the above is incorrect, give details:

    DECLARATION BY CLIENT:
    * I hereby grant the Credit Provider the right to communicate with me through any electronic/written media or verbally in order to make 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 Products needed and requested by me.

    YESNO

    * I hereby give consent to the Credit Provider to make enquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the application. I also give consent to the Credit Provider to share my payment behavior with any credit agency.

    YESNO

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    Rally Motors is a used car dealer in Bloemfontein that offers you top quality used cars for sale that you can rely on.
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