SMR Associates

Financial Services

LOAN APPLICATION F
South African National Office
718 Management House cnr Melle &
Jorrisen Braamfontein JHB
Tel: 011 403 3419 FAX:0866089666

Loan applied for

Housing ___
Personal Loan ___
Car Finance___
Title

Mr__ Mrs__ Miss__Dr__ Prof__

Surname
_____________________________________________________Initials__ ________
Maiden Name ________ _________Date of Birth______________________
Marital Status __ __Married__Divorced___Widow/er if Married___COP__ANC__Traditional
Natinality
_______ ___________ Language_________No of Dependants_________
Identity Type ___RSA ID __Other Please Specify___________________
ID No
_____________ Gender __Male__Female
Occupation _____________________________________________________________
Employer
_______________________________________________________________
HR Officer _
____________ Tel____________________________
Employer Phisical Address__Protea
__________________________________________________________
Employment Date_____________________
Employment ___Contract_*_Permanent___Temporary Employee /Clock no_________________
Previous Employer_____________________________Period of previous employment____________
Payment
__*_Monthly___Weekly___Bi-Weekly
Are you
___Tenant ____Owner _*__ Other Specify____Living with Perants__________
Tel (h)
___________________________Mobile_____________________
Tel (w)
___________________________
Res Address ___ _________________________
__________________________________________________Code___________
Postal Address____ ______________________________
__________________________________________________Code___________
Have you been :
Insolvent
__Yes __No
If so, have you been rehabilited

Under administration __Yes __No

__Yes __No
If yes, date _________________________

Section B: Spouce/co-applicant details

Title __Mr __Mrs __Ms __Miss __Dr __Prof
Surname
___________________________________Initials______________________________
Full Names ______________________________________________________________________
Maiden Name ______________________________Date of birth______________________________
Marital status ___Single___Married __Divorced___Widow/er If Married _COP _ANC__Traditional
Nationality
________________________Language___________No of Dependants_____________
Identity type ___RSA ID __Other Please specify______________
ID no
______________________________Gender__Male __Female
Occupation _____________________________Employer__________________________________
H.R Officer _____________________________Tel No __________________________________
Employer Address___________________________________________________________________

Page2
Section B: Continued
Employer start date ______________________
Employment
__Contract __Permanent __Temporary
Employee/clock no:___________
Previous employer _______________________Period of pevious employment ______________
Payment ___Monthly ___Weekly ___Bi-weekly
Are you ___Tenant
___Owner ___Other Specify_____________________________________
Tel (h)
________________________________Mobile___________________________________
Tel (w) ________________________________
Res address_______________________________________________________________________
______________________________________________________Code_____________
Postal Address____________________________________________________Code_____________
Have you ever been:
Insolvent___Yes __No
Under administration__Yes __No
If so, have you been rehabilitated? __Yes __No If yes, date _____________________________
SECTION C:Next of kin (other than spouse)
Title __Mr
Surname
Full Names
Date of birth
Tel (h)
Tel (w)
Res address

__Mrs __Ms _*_Miss

__Dr __Prof
___
_________________________________Initials________________
___
___________________________________________________
________________________ Relation ___________________________
________________________ Mobile_______________________
________________________
__
______________________________
_____________________________________________________Code_______

SECTION D: Loan particulars

Loan amount applied for R__
_________or max pre-qualification__
Erf no____________ Portion_________Unit no._____ In townhouse/ scheme _______Ext________
Type of ownership __Full title
__Section
__Building loan
__Existing house
SECTION E Colleteral detail
Cash deposit available ? ___Yes _*_No If yes R_________________
Monthly housing subsidy ___Yes _*_No
If yes R_________________
Employer collateral available? ___Yes _*_No If yes R________________
BANK DETAILS
Account Holder
Branch Name

Account no.___
____Bank__
_
Branch code
Type of account___Cheque_Savings__Transmission

i. I testify that the information I have provided is true.

ii. And I therefore accept that I will pay 8% commission to SMR ASSOCIATES after I have received
my loan.
Signed at Centurion on this date

Signature

Witness / Co-applicant On behalf of SMR ASSOCIATES: