Loan details

    Loan Amount required:

    Proceeds available on registration:

    Expected date of registration:

    Purpose of loan:

    Personal details

    Full name and surname:

    Identity Number:

    Full name and surname:

    Identity Number:

    Contact Numbers:

    Home:

    Work:

    Cell:

    Fax:

    E-mail:

    Physical address:

    Postal address:

    Banking details

    (current or savings only)

    Name of account holder:

    Bank:

    Account number:

    Branch:

    Branch code:

    Conveyancer

    Coneyancing firm:

    Tel:

    Fax:

    E-mail:

    Contact Person:

    Nature of underlying transaction: Sale of propertyNew Mortgage bond

    Property description:

    If the underlying transaction is a transfer of property:

    Seller:

    Purchaser:

    Selling Price:

    Existing bond amount:

    If the underlying transaction is the registration of a new or further mortgage bond:

    Bank:

    Bond amount:

    Registered owner:

    The following information is required for statistical purposes by the National Council Regulator

    Gender: MaleFemale
    Are you a resident of a rural or low density area? YesNo
    Are you a historically disadvantaged person? YesNo
    Your monthly gross income category: Below R3,500.00R3,501.00 - R5,500.00R5,501.00 - R7,500.00R7,501.00 - R10,000.00R10,000.00 - R15,000.00More than R15,000.00
    Reason why require bridging finance: Housing and relatedEducationSmall businessServicesEmergency(see below)Other
    Emergency loans analysis: Death or funeralMedicalIncome lossTheft or fireOther emergency

    Important: This application cannot be processed unless all the required details are supplied.