A. Lead Provider Details:
Company Name   _____________________________Consultant Name _________________________
Consultant Tel Number ________________________ Consultant Email _________________________

B. Applicant Details
Client Full Names       _________________________________________________________________
ID Number                  _________________________________________________________________
Email Address             _________________________________________________________________
Phone Number (home)_________________________________________________________________
Cell Number                _________________________________________________________________
Fax Number                _________________________________________________________________
Address                       _________________________________________________________________
Are you listed at any Credit Bureau?           Yes or No  _______________
Are you under:      Admin order?                 Yes or No  _______________
                              Debt review?                  Yes or No  _______________
                              Debt counselling?           Yes or No  _______________
                              Sequestration?                Yes or No  _______________

C.  Vehicle
Description of vehicle you are wanting to buy         ___________________________________________ 
Model of vehicle (to be no more than 8 years old)   ___________________________________________
Private sale or from established dealer?                    ___________________________________________

Please send the following supporting documents:-

• Clear copy of ID
• Clear copy of driver’s licence
• Payslips  -  3 months
• Bank statements  -  3 months

DECLARATION:

I (applicant name) _______________________________________________ hereby:

- accept the conditions as set out above and authorize Mr. R C Pretorius to irrevocably proceed with the arrangement of vehicle finance for me.

-  acknowledge that Mr. R C Pretorius has earned professional fees in the amount of 2 % (Two Percent)  for arranging my vehicle finance and that the professional fees are only due and payable on final approval of the vehicle finance. Should no approval be granted no fees are due or payable.

-  agree that the professional fees to be paid to Mr. R C Pretorius, will be included in the loan amount.

-  expressly authorize and instruct the vehicle finance company to pay to Mr. R C Pretorius his professional fee for the agreed professional services executed, from the loan advanced.
-  authorise and give my consent to Mr R C Pretorius and / or his agent and/ or credit provider to make enquires from time to time through any credit bureau or similar institution as to my personal circumstances, my credit profile, bank records and credit worthiness.
- consent to and authorise MR R C Pretorius and / or his agent and / or credit provider to disclose the information provided herein, the information obtained from any credit bureau or institution referred to above, as well as my payment and credit performance, to any other person, company or bureau without further reference to me.

Signed at _________________________ this ________ day of ______________________20_____.

_________________________                               ___________________________
Client                                                                               Witness

 Fax to 0866 033843   or    Scan and Email to: info@nhfinance.co.za