SECTION A - PERSONAL DETAILS If you are applying as the Primary Applicant Only, please complete this form once. If you are applying with both the Primary and Co-Applicant, the form will need to be completed twice, first with the Primary Applicants Information followed by the Co-Applicants Information. Primary Applicant or Co-Applicant Primary ApplicantCo-Applicant Title MissMrsMrProfDrMejMevMnrMsMe Gender MaleFemale First Name/s Surname ID Number ID Type ID BookSmart ID CardPassportRecognised Refugee in SA (Section 24)SA Refugee Identity (Maroon ID) Ethnic Group AfricanAsianColouredWhite SA Citizen YESNO FOREIGN APPLICANT DETAILS Passport, country of issue County of Birth City of Birth Nationality SA Permanant Resident YESNO Passport Number [PassportNumber] Are you a temporaryResident of SA YESNO Expiry Date of Passport Permit Type PermanantStudyWorkOther Permit Number Permit Expiry Date MARITAL STATUS DETAILS Marital Status SingleMarried COPMarried ANC with AccrualMarried ANC without AccrualDivocredOther If married in ANC or Married in COP, Name and Surname of Spouse No of Dependants If married, with Foreigner country of marriage SA Income Tax Number Do you file any Tax Returns outside of SA YESNO If so, country and tax number RESIDENTIAL STATUS OF THE APPLICANT Current residential status OwnerTenantOther Are you a first type home buyer? YESNO Will this property be your main residence? YESNO Highest level of education No MatricMatricCertificate 24 MonthsDiploma 1 YearsDiploma 2 YearsDiploma 3 YearsDegreePostHonoursMastersDoctorate Do you currently smoke, or have you smoked in the last 12 months any form of tobacco or e-ciggarettes? YESNO Next Step 2 of 10SECTION B - CONTACT DETAILS OF THE APPLICANT Home Number Cellphone Number Work Number Email Address Fax Number Home Language Language of Correspondence RESIDENTIAL ADDRESS Street Suburb City Postal Code Country Length at current address POSTAL ADDRESS Same as residential address YesNo Street/PO Box[text Street/PO] Suburb City Postal Code Country Legal notice delivery method Hand deliveredRegistered Mail BackNext Step 3 of 10SECTION C - EMPLOYMENT DETAILS OF THE APPLICANT Occupation Status Full-time employedPart-time employedSelf-employedTemporary employedHome executiveUnemployedPensioner Occupation Level Senior ManagementManagerSupervisorSkilled workerSemi-skilledUnskilledJunior position EMPLOYMENT DETAILS - (Employed Only) Name of Occupation Employer Name Employee Number Employment Period (Years and Months) Employer Contact Number Street Suburb City Postal Code Country Percentage of income derived from own business (if any) Company Name Company Registration Number Are you a shareholder at your employers business? YESNO Percentage shareholding (if yes) Does this purchase relate with a job change? YESNO Were you previously employed? YESNO PREVIOUS EMPLOYMENT DETAILS - (two Most Recent) Previous Employer 1 Duration (Years and Months) Previous Employer 2 Duration (Years and Months) BackNext Step 4 of 10SECTION D - CREDIT STATUS OF THE APPLICANT Are you currently under Administration? YESNO Were you ever under Administration? YESNO Has a Judgement ever been taken against you? YESNO Are you currently under debt review? YESNO Are you currently under any debt re-arrangement? YESNO Have you ever been declared insolvent? YESNO Are you aware of any adverse credit listings? YESNO Are you currently in credit bureau dispute? YESNO EXISITING SURETYSHIPS Are you bound by any surety agreements? YESNO If yes, specify amount Are you currently paying off this account? YESNO Monthly Installment Details of suretyship Will you be settling this account/debt YESNO New Installment Surety in favour of BackNext Step 4 of 10SECTION E - DETAILS OF THE PROPERTY YOUR ARE INTENDING ON FINANCING Erf Number/Section Number/House Number Street/Complex Suburb New Loan/Further Loan Amount Required Amount to be Registered Do you require an additional amount to be registered for solar energy? (Solar finance available only through FNB) YESNO Solar energy loan amount required (min R50k, max 15% purchase price) BackNext Step 6 of 10SECTION F - MONTHLY INCOME AND EXPENDITURE OF THE APPLICANT MONTHLY INCOME Gross Salary Average Commission Investment Income Rental Income Car Allowance Travel Allowance Entertainment Allowance Income from sureties Housing subsidy Maintenance/Alimony Average overtime (past 6 months) Other Income (Description and Amount) Other Income (Description and Amount) MONTHLY DEDUCTIONS Tax (PAYE/SITE) UIF Pension Medical Aid Other Deductions (Description and Amount) Other Deductions (Description and Amount) Total Deductions Income After Deductions MONTHLY EXPENSES Rent (only if ongoing) Maintenance/Alimony Rates and Taxes/Levies Water and Electricity Assurance (life, retirement, annuities, insurance and funeral polices) Groceries Transport, petrol and car maintenace Education Medical (excl medical aid salary deductions) Cellphone/Internet (If no on contract) M-Net, DSTV and TV Security Other Expenses (Description and Amount) Other Expenses (Description and Amount) Total Expenses Net surplus income/deficit BackNext Step 7 of 10SECTION G - PRIMARY TRANSACTUAL BANK ACCOUNT DETAILS AND CONTRACTUAL EXPENSES - OF THE APPLICANT Bank/Financial institution of the Applicant Branch Account Type Account Holders Name Is this account in the name of a Legal Entity? YESNO Business Bank Account? YESNO Account Number For FNB, RMB and Standard Bank Primary Banked Customers Only: Your bank has requested the oppotunity to consider your home loan application first for a period of time. I consent to this arrangement YESNO HOME LOANS Do you have an existing home loan, if yes complete the below. If no select no and leave the rest blank YESNO Bank/Financial Institution Branch Account Holders Name Outstanding Balance Monthly Installment/Minimum Payment Are you selling the existing property? YESNO New Installment (if reduced) OTHER BANK FINANCE ACCOUNTS (CREDIT CARDS, VEHICLE FINANCE, PERSONAL LOANS ETC) Bank/Financial Institution Account Type (Credit Card, Vehicle Finance etc) Current Balance Monthly Payment Will this account be settled? YESNO Is this a Business Account? YESNO Is this a Legal Entity Account? YESNO RETAIL ACCOUNTS Name of Retail Store Currently Balance Monthly Payment Will this account be settled? YESNO BackNext Step 8 of 10SECTION H - ASSETS AND LIABILITIES - OF THE APPLICANT Fixed Property Market Value Fixed Property Liabilities Vehicles Market Value Vehicles Liabilities Investments Market Value Investments Liabilities Furniture and Fittings Market Value Furniture and Fittings Liabilities Other Assests/liabilities Market Value Other Assests/liabilities Liabilities Total Assets Total Liabilities Net Asset Value BackNext Step 9 of 10SECTION I - DECLARATION AND CONSENTS - PRIMARY APPLICANT I/We, the undersigned, a) Consent to Tholulwazi Capital making an application for home loan finance on my/our behalf/ b) Consent to an insurance representative calling me/us to advise on my/our mandatory buildings insurance and my/our mortgage protection requirements related to my/our home loan application once it is granted. c)Acknowledge that personal, financial and other information is furnished to Tholulwazi Capital for the purposes of making an application for home loan finance and are aware that I/We are required to furnish all such information truthfully and fully. d) Consent to Tholulwazi Capital receiving all communications from the bank/s (including the quotation) pertaining to my/our home loan application. I/we consent to Tholulwazi Capital sharing the bank/s decision on my/our home loan application the estate agent and issuing the estate agent with a copy of the bank/s quotation. e) Consent to the bank/s only contact me/us after Tholulwazi Capital has notified the bank of my/our acceptance of the bank's quotation. f) Consent to Tholulwazi Capital and third parties, including banks, making enquiries to credit bureaux when assessing my/our home loan application for finance. g) Hole no other citizenships and residence for local and international tax purposes, other than the disclosed in the application form and I/we will inform the lender in writing of any change of this status within 30 days of the change of status. h) Consent to Standard Bank, ABSA and Nedbank electronically retrieving my/our bank statements. i) Do hereby appoint Tholulwazi Capital as my/our lawful representative and agent to process my/our personal information to obtain a copy of my/our personal credit report/s ("PCR") from the registered credit bureau, including via a registered reseller provider. I/We consent to the credit bureau and/or other registered provider releasing a copy of my/our PVC to Tholulwazi Capital to review solely for th purpose of providing me/us with advice of assistance with managing my/our credit. j) Consent that the bank may obtain and use my /our information from third-part qualification data providers to conduct an assessment to determine my/our eligibility for, and the appropriateness of, the home loan. k) Give consent to the bank to process my/our personal information to do fraud checks, as well as checks and reporting to the South African Fraud Prevention Services. l) I/We irrevocably consent that Nedbank and First Nation Bank may request my/our salary advice from my/our employer (s) m) Consent, after my mortgage bond is registered, to receiving estate planning advice of a free Will and to explore any changed insurance requirements. I/We are aware that I/We can opt out at any time. n) I/We, the undersigned, consent to Tholulwazi Capital making application to the NHFC on my/our behalf and FLISP and the Tholulwazi Capital to receive all communication from the NHFC pertaining to my/our FLISP application, including the final outcome of my/our application. I/We understand the purposes of which my/our personal information is required and for which it will be used by Tholulwazi Capital and the NHFC. Last Page 10 of 10
