Welcome to Emond Auto Personal Finance Application Form.

If you do not owe anything or do not have any details, fill in with a 0.

Sales Representative

Which Vehicle (ie 2010 2.0)

Personal Details

Title

Surname

Full Names

Cell Number

Email Address

Sex

ID Number

No. Of Dependants

Marital Status

Marital Contract

Date of Marriage (dd/mm/yyyy):

Home Address

Street 1:

Street 2:

Street 3:

Suburb :

Find Postal Code

City :

Postal Code:

How long have you stayed at this address? (Years/Months):

Postal Address :

Copy Physical Address

P.O. Box 1 :

P.O. Box 2 :

P.O. Box 3 :

P.O. Box Suburb :

Find Postal Code

P.O. Box City :

P.O. Box Postal Code :

Telephone(Home):

Telephone(Work):

Spouse Name(if Married):

Spouse ID(if Married):

Spouse Cell Number(if Married):

Details of Somebody NOT Living With You

Name:

Surname:

Cell Number:

Relationship

Address:

Employer Details

Employers Company Name:

Managers Name:

Occupation

How long have you worked there?:

Employers Address:

Employers Telephone:

What date do you get paid:

Banking Details

Who do you Bank With?

Type of Account?

Bank Branch Name?:

Bank Account Number?

Bank Branch Number?

Name of Account Holder

Income and Expenses

Total Income Before Deductions

Total Income After Deductions

Total Expenses ie Rent, Vehicles, Food, Telephone, Electricity, etc

Breakdown of Expenses

Bond Payment / Rent

Rates, Water, & Electricity

Vehicle Installments

Personal Loan Repayments

Credit Card Repayments

Furniture Accounts

Clothing Accounts

Overdraft Repayments

Insurance Repayments

Telephone Payment

Transport Costs

Food and Entertainment

Education Costs

Maintenance

Household Expenses

Other

Agreement

By checking the check box below I hereby give consent to the Credit Provider to make enquiries about my credit record with any of credit agencies and to obtain whatever information on me that they might require to process the credit application and / or application for insurance. I hereby declare that all of the above information is true and correct . I also consent to all related parties for the collection and use of this information. *

SUBMIT