NOTE: This form was emailed as a auto-response to your enquiry. If the form does not apply to your finance needs, please contact a New Heights Finance consultant
on 086 603 3843.

Application and Agreement
Bridging Finance Pension / Provident

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            ________________________________________________________________
Cell Number                 ________________________________________________________________
Residential Address    ________________________________________________________________
New Residential Address _____________________________________________________________
Current Work Address________________________________________________________________
New Work Address    _________________________________________________________________

Has the Applicant resigned yet?                     y/n
Has the applicant completed his/her Pension/ Provident fund withdrawal notice     y/n
In the case of the withdrawal notice having been completed, indicate, when anticipated payout ?  ____/_____/ 2008

What is the total value of your pension                                                             R_______________

How much of the pension, would you like to bridge. Approximately           R_______________

Documents Required

ID.
Last pay-slip.
Letter of appointment with new company (where applicable).
Pension / Provident Fund Statement.
Acknowledgement of receipt of withdrawal notice (where applicable).
Short motivation note, as to why funds are needed and your future employment or business plans.



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 a bridging loan on my pension / retirement annuity for me.

- acknowledge that Mr. R C Pretorius has earned professional fees in the amount of 5 % (Five Percent) for arranging my bridging finance and that the professional fees are only due and payable on final approval of the bridging 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 bridging 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 history 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 ________________2007. Client _________________________                     Witness ___________________________
Co-Applicant __________________________      Witness ___________________________

Fax to :  086 603 3843 | Email to:  admin@nhfinance.co.za