Application for Consolid8™ Financial Planning Please complete this application and fax back to us
Consultant Name: Company Name: NEW HEIGHTS FINANCE   Direct Fax Number: 0866 283 669 A - Personal Details Applicant Title Mr.   Mrs.   Miss.   Ms.   Dr.   Prof.   First Name   Surname   Date of birth (ddmmyyyy) Gender: Male   Female   South African ID no   SA Citizen Yes   No   Race African   White   Indian   Coloured   Other   Preferred language English   Afrikaans   Other   Marital Status Single   Married   Divorced   Widowed     If married, how? ANC   COP   Traditional   Declared insolvent Yes   No   If yes, data: Been rehabilitated Yes   No   If yes, data: Under administration Yes   No   Under debt review/counselling Yes   No   Physical address (street)   Suburb   Town/City   Code Postal Address   Suburb   Town/City   Code Telephone no. (w) (             ) Telephone no. (h) (             ) Telefax no (             ) Cellular   Email adress   Number of dependants (if any)   Ages of dependants (if any)

A - Personal Details

Co- applicant / Spouse / Surety

Title	Mr.   Mrs.   Miss.   Ms.   Dr.   Prof.
First Name
Surname
Date of birth (ddmmyyyy)	dd mm yyyy Gender: Male   Female
South African ID no
SA Citizen	Yes   No
Race	African   White   Indian   Coloured   Other
Preferred language	English   Afrikaans   Other
Marital Status	Single   Married   Divorced   Widowed
	If married, how? ANC   COP   Traditional
Declared insolvent	Yes   No   If yes, data:
Been rehabilitated	Yes   No   If yes, data:
Under administration	Yes   No
Under debt review/counselling	Yes   No
Physical address (street)
Suburb
Town/City	Code
Postal Address
Suburb
Town/City	Code
Telephone no. (w)	(             )
Telephone no. (h)	(             )
Telefax no	(             )
Cellular
Email adress
Number of dependants (if any)
Ages of dependants (if any)

B - Employment details

Applicant

Employment status	Employed   Self-employed   Other:
Occupation
Type of employment	Permanent   Temporary   Contract
Service period	Months
Type of income	Salary   Wages   Commission   Other:
Name of Employer
Employer address (street)
Suburb	Town/City: Code:
Employer Telephone no	(             )
Previous Employer
Previous Length of service	Months

B - Employment details

Co-applicant / Spouse / Surety

Employment status	Employed   Self-employed   Other:
Occupation
Type of employment	Permanent   Temporary   Contract
Service period	Months
Type of income	Salary   Wages   Commission   Other:
Name of Employer
Employer address (street)
Suburb	Town/City: Code:
Employer Telephone no	(             )
Previous Employer
Previous Length of service	Months

C - Banking Details

Applicant

Repayment options	Debit order   Salary deduction
Account Holder
Account number	Bank Name:
Branch name	Branch code:

C - Banking Details

Co-applicant / Spouse / Surety

Repayment options	Debit order   Salary deduction
Account Holder
Account number	Bank Name:
Branch name	Branch code:

D - Financial details	Applicant		Co-applicant / Spouse / Surety
Monthly income
Gross income (cost to company)	R		R
Nett income (after deductions)	R		R
Other income	R		R
Monthly Expenses	Monthly Installment	Balance	Monthly Installment	Balance
Personal loans	R		R
Motor finance (all vehicles)	R		R
Mortgage bonds	R		R
How much do you spend on:	R		R
Water & Lights, rates & taxes	R		R
Monthly insurance premiums	R		R
Groceries and tioletries	R		R
Petrol per month	R		R
Public transport	R		R
School fees	R		R
University fees	R		R
Cellular contracts	R		R
Telkom account	R		R
DSTV / Mnet	R		R
Security company installment	R		R
Alcohol and tobacco	R		R
Domestic / Gardener	R		R
Credit card minimum payment	R		R
Clothing an footwear	R		R
Alimoney / Maintenance	R		R
Entertainment	R		R
Home maintenance	R		R
Building complex levies	R		R
Other subscriptions	R		R
Other monthly expenses	R		R