RENT TO OWN APPLICATION Application DetailsFirst Name Middle Name Last Name Title - Select -Mr.Mrs.Ms.Dr.Gender - Select -Male FemalePrefer not to sayMartial Status - Select -Married (COP)Married (ANC)SingleDivorcedWidow/erIdentity Number Email Telephone Number (Home) Telephone Number (Work) Cell Number Home AddressAddress Line 1 Address Line 2 City State Zip Code Period Residing at Residence (YY-MM) Employment DetailsEmployer Name Email Phone/Mobile Type of Industry Occupation Employee number Period at Current Employer Period at Previous Employer Home OwnershipDo you own your property? Yes No Bond Free On House BondWhose Name? In Your Name In Your Spouse's Name In Both NamesHome Type House Flat Townhouse Apartment OtherTime at your previous residence (YY-MM) Spouse Details (If COP)First Name Last Name Email Phone/Mobile AddressAddress Line 1 Address Line 2 City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweIdentity Number Gross Monthly Income (R) Employer Name Employer Address Applicant's Banking DetailsSome description about this sectionAccount Type Cheque Saving TransmissionAccount Holder Name Bank Name Account Number Branch Name Branch Number Applicant's Income DetailsGross Monthly Income (R) Source of Income Salary Commision OtherTotal Monthly Expenses (R) Applicant's Disposable Income Are you currently labled as: Surety Guarantor Co-DebtorTransaction DetailsInverter Size - Select -5kW8kW12kW16kWOtherNumber of Batteries - Select -1234OtherNumber of Panels System Cost (Including Installation) Financial Periods - Select -24 Months36 Months48 Months60 Months72 MonthsDeposit (R) Preferred Debit Order Date: Numeric Field Pre-Screening QuestionsI confirm that:I am not a minor. Yes NoI have never been declared mentally unfit by a court. Yes NoI am not subject to an administration order. Yes NoI do not have any current application pending for debt restructuring or alleviation. Yes NoI do not have any current debt re-arrangement in existence. Yes NoI have not previously applied for a debt-re-arrangement. Yes NoI am not under sequestration. Yes NoI do not have applications pending for credit, nor open quotations as envisaged in section 92 of the National Credit Act. Yes NoIf any of the above is incorrect, state which and give details: Credit ConsentI understand that I will be liable for a monthly service fee.I consent to this Credit Provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Provider’s obligation under the National Credit Act.I hereby declare that the information provided by me is true and correct.I consent to the bank making enquiries about my credit record with credit reference agencies and credit bureau for the purposes of assessing the credit application or updating my information in future. Ialso consent to the bank sharing information with such agencies about how I manage this loan agreement, who may in turn share this information with other credit providers.I consent to identity and fraud prevention checks and sharing information relating to this application through the South African Fraud Prevention Service. Yes NoDocuments RequiredClear Copy of ID Choose File 3 Months Banking Statements (6 Months if Commission earner) Choose File 3 Months Salary Slips (6 Months if Commission earner) Choose File Proof of Address in your name (Not older than three months) Choose File Copy of System Quotation Choose File Thank you for submitting your applicationOur Account's department will verify the above details and contact you within the coming days to arrange the final contracts, signatures and details regarding your installation! Good Luck! Submit Form
