Phone Application Type * Individual Joint Full names and Surname * ID number * Email * SARS Tax Number * Phone (home) Phone (Work) * Phone (Mobile) * Address * Highest level of education * Certificate 24 Months Degree 3 and 3+ Years Diploma 1 Year Diploma 2 Years Diploma 3 Years Doctorate Honours Incomplete Masters Post Graduate Diploma 12 Months School Leaver - Grade 10 School Leaver - Grade 12 School Leaver - Pre Grade 10 Employment sector * Agriculture Armed forces Catering & Entertainment Civil Service Communication Construction Education Finance Health Industrial I.T. Legal Profession Media Nature Reserves Sales & Marketing Science Security Transportation Welfare Other Employer * Duration of Employment * 0 > 1 Years 1 > 2 Years 2 > 3 Years 3 > 5 Years More than 5 Years Employer Address * Previous Employer * Marital status * Single Married Seperated Divorced Widower City of Birth * Number of Dependants * Have you ever been declared insolvent ? * No Yes Are you under administration / debt counceling ? * No Yes Banking Details Account name * Bank Account type * Cheque Credit Savings Other Account number * Basic Salary * Commission * If not applicable enter 0 Allowance * If not applicable enter 0 Overtime * If not applicable enter 0 Rental income * If not applicable enter 0 Other income * If not applicable enter 0 NET INCOME Total: R Expenses PAYE * Pension / Provident fund * If not applicable enter 0 UIF * If not applicable enter 0 Medical aid * If not applicable enter 0 Other deductions * If not applicable enter 0 Electricity / Water / Rates / Levy * If not applicable enter 0 Rent / Bond If not applicable enter 0 Will this bond be Settled? * Yes No Not applicable Groceries / Food * Petrol * If not applicable enter 0 Education * If not applicable enter 0 DSTV * If not applicable enter 0 Insurance * All insurance including short term, life and funeral policies. If not applicable enter 0 Entertainment * If not applicable enter 0 Car Finance * If not applicable enter 0 Retail store accounts * If not applicable enter 0 Credit card repayments * If not applicable enter 0 Revolving credit agreements * If not applicable enter 0 Personal loan agreements * If not applicable enter 0 Other expenses (Please specify here) * Total of other expenses * If not applicable enter 0 TOTAL EXPENSES Total:R DISPOSABLE INCOME Total:R Property Details First time home buyer ? * Yes No Property Use * Owner Occupied Rented Out Vacant Land Holiday Home Business Full address of property being purchased ? * Property Type * Dwelling Sectional Title Cluster Smallholding Vacant Land Legal description of property (Erf or section number description) * Purchase price * Deposit * Loan amount required * Total: R Agents name Agents phone number Sellers name Sellers phone number Contact person for valuation Valuator's contact number Transferring attorney Transferring attorney contact number I warrant that all the information I supplied is to the best of my knowledge and belief true and correct in all material respects. I hereby appoint the Originator, Mortgage Max , as my sole agent to obtain mortgage loan finance for this property on my behalf. I agree that the bank can provide any information pertaining to the loan applied for, sharing positive and negative information to the Originator during the application process. I hereby authorise the Bank to have access to my credit bureau records, and to furnish or to disclose any information arising from any agreement entered into with the Bank to any such credit bureaus. I hereby authorise the originator to perform credit checks and to supply my details to their exclusive business partners to enable them to provide me with tailored quotes for products to suit my circumstances. My details will not be shared with any other parties. I/We hold no other citizenships and residencies for local and international tax purpose, other than those disclosed in the application and will inform the lender in writing of any change within 30 days of the change of status. Acceptance * Yes No Signature This document will be mailed to you using Sign Request for your Signature Uploads File size limited to 5mb per file. Only jpg, gif, png or pdf will be accepted. MOBILE USERS : Check the size settings of your camera before taking photos of documents, recommended size of less than 6 Megapixels (3264 X 1840) Upload ID's ID Add Files Accepted file types: jpg, gif, png, pdf. Proof of Residence Proof of Residence Add Files Accepted file types: jpg, gif, png, pdf. Payslips Payslips Add Files Accepted file types: jpg, gif, png, pdf. Other Documents Other Documents Add Files Accepted file types: jpg, gif, png, pdf.