APPLICATION FOR VEHICLE FINANCE – INDIVIDUAL
New
Goods description Model Make M&M code
Used
Dealer/Supplier Tel no
F&I Contact person MFC Marketer Fax no
Cash price (VAT incl.) R Vatable extras (VAT excl.) R Instalment Sale Lease
Fuelling R Finance amount R Initiation fee Include Exclude
Licence/Registration fee R Term Balloon R
Delivery fee R Rate Instalment R
Deposit/Trade-in R
PERSONAL DETAILS
Client subtype SA citizen residing in SA Foreign national residing in SA
Asylum seeker Refugee SA citizen residing abroad
Title Surname Identity no
Full names Initials
Place of birth Nationality Male Female
Ethnic group African Coloured Indian White
Language preference English Afrikaans Other
Marital status Single Married Divorced Widowed
If married, how married? COP OCOP Customary/Tribal law Married under foreign law Date married
ADDRESS AND CONTACT INFORMATION
Home address Postcode Period at address
Postal address Postcode Residential status
Country of residence Residential address/Geographic location
Tel (h) Tel (w) Cell Email
Do you have tax obligations, tax liabilities or tax residencies outside SA? Yes No
Are you a US citizen, a US person or a US national? Yes No
Are you a registered VAT vendor? Yes No If ‘Yes’, VAT reg no
For what purpose will the goods be used? Taxable Non-taxable
SPOUSE AND NEXT OF KIN INFORMATION
Spouse name Spouse identity no
Next of kin Relationship
Address Tel
EMPLOYER DETAILS
Current employer No of years with employer
Industry type Occupation
Salary date
BANKING DETAILS
Bank name Branch name Branch code
Name of accountholder Account no
Type of account: Savings Current
Source of income Salary earner Self-employed Commission Director
Pension Maintenance Court order Member of a corporation
Applicant initials
MFC, a division of Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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MONTHLY INCOME AND EXPENSES
Applicant income details Spouse/Partner income details
Basic salary R Basic salary R
Car allowance R Car allowance R
Commission R Commission R
Overtime R Overtime R
Other R Other R
Source of other income (eg maintenance) Other household income
Total salary R Total salary R
Net salary R Net salary R
Total monthly income R Total monthly income R
Household expense details
Bond payment R Rates, water and electricity R
Vehicle instalments (excl.those to be settled) R Personal-loan repayments R
Credit card payments R Furniture accounts R
Clothing accounts R Overdraft payments R
Policy/Insurance premiums R Telephone payments R
Transport costs R Food and entertainment R
Education costs R Maintenance R
Property rent R Other R
Total monthly household expenses R
Total monthly income R
Less: Total monthly household expenses R
Total monthly disposable income R
EXPLICIT CONSENT
• I give my express consent to you to make enquiries about my record with any credit agency. I also give you consent to share
my payment behaviour with any credit agency. Yes No
• I give my express consent to you to request my payslips from my employer, for the purpose of applying for vehicle finance. Yes No
• I give my express consent to you to get bank statements for the bank account(s) detailed below, for the purpose of applying
Yes No
for vehicle finance.
ELECTRONIC BANK STATEMENT DETAILS
Bank name Branch name
Name of accountholder Branch code
Account no Account type
COMMUNICATION AND MARKETING
1 I would like Nedbank to inform me of new Nedbank products and special offers. Yes No
2 I would like Nedbank to present exclusive offers from other organisations to me. Yes No
3 Nedbank may request reputable research organisations to contact me. Yes No
4 My preferred method of communication is as follows: Email SMS Direct mail Telephone All
5 Nedbank may use a method of communication other than that preferred by me as well as my personal information to market
its products to me, including electronic marketing and telesales, until I give an instruction to the contrary. Yes No
GENERAL INFORMATION
Your privacy is very important to Nedbank and we will use all reasonable efforts in order to ensure that any information, including personal information provided
by you, or which is collected from you or from third parties is processed, transferred and stored in a secure manner.
Apart from the information you will provide in your application, Nedbank may require additional documentation and information from you.
Where the words 'I', 'me', 'my', 'you' and 'your' are used, these refer to the party giving consent to Nedbank (including all its affiliates, cessionaries and associates)
in terms of this Standard Declaration document.
PRIVACY CONSENT
I give consent to Nedbank to process my personal information in relation to my applications for financial products and/or services from Nedbank, subject to
Nedbank’s privacy policies and within the parameters of applicable laws. The processing will include without limitation conducting affordability assessments,
credit scorings and any other profile building, that can assist Nedbank to appropriately allocate a product or service offering that is suited to your needs. The
consent will also extend to Nedbank processing my personal information as Nedbank may deem fit for my and/or Nedbank legitimate interest.
Applicant initials
MFC, a division of Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
Page 2 of 3 Application for Instalment Finance Individual.dotm 28Jan21 | SD2
I also give Nedbank the right to:
1. collect my personal information from a third parties when reasonably necessary and/or if it is impracticable to collect the data directly from me;
2. share my personal information with third parties if necessary, to provide financial products or services to me;
3. process my personal information for purposes of complying with any legislative or regulatory requirements;
4. transfer and/process my personal information outside the Republic of South Africa, where necessary, on condition that such transfer and/or processing
is subject to applicable laws binding corporate rules or binding agreement;
5. process my special personal information (such as race, ethnic origin, biometric information or alleged criminal behaviour), only where necessary and
subject to Nedbank’s Privacy Policy and applicable laws.
YOUR RIGHTS
You have the right to:
1. request confirmation from Nedbank, free of charge, whether or not we hold your personal information;
2. request the record or a description of your personal information held by Nedbank;
3. request information about all third parties who have, or have had, access to your personal information; and
4. to correct or delete your personal information.
5. withdraw your consent at any time by providing notice to Nedbank;
6. object to your personal information to be held by Nedbank;
7. lay a complaint at the Information Regulator regarding your personal information in terms of the Protection of Personal Information Act.
CONFIRMATION
i. Nedbank has explained this application form, the product and costs, where applicable, to me and I confirm that I fully understand the contents and
that I am completing it of my own free will.
ii. I warrant that I have fully answered all questions and responded to requests for information truthfully as part of the assessment process, and that I
am not aware of any other information that may affect this application negatively.
iii. Nedbank may undertake identity and fraud prevention checks and share information relating to this application with South African Fraud Prevention
Services.
iv. All consents provided in this document, will survive any contractual relationship that I have with Nedbank, unless I withdraw such consent in
accordance with the various methods of communication provided by Nedbank...
I hereby declare that:
i. I have never been declared mentally unfit by a South African court.
ii. I am not subject to administrator order.
iii. I do not have any current application pending for debt restructuring or alleviation;
iv. I have not applied for any debt re-arrangement.
v. I am not under sequestration; and
vi. I do not have applications for credit pending, nor open quotations as envisaged in section 92 of the National Credit Act, 34 of 2005.
I hereby declare that all of the above information is true and correct.
Applicant's signature Date
MFC, a division of Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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