Applicant details

Contact details
Solvency
Please complete for statistical reasons
Bank details
Home Loan, Liberator and Business Mortgage application
Main applicant
*Co-applicant/surety must complete form 00142191
Hierdie vorm is ook beskikbaar in Afrikaans, vorm 00141480
For new Loan, please complete Section: A, C, F, G.
Liberator, please complete Section: A, B, C, E, F, G.
Business Mortgage, please complete Section: A, B, C, D, F, G.
Type of application Private individual
Title
Surname
Date of birth
(YYYY-MM-DD)
Are you a South African citizen?
Antenuptial contract?
Have you ever been declared insolvent (bankrupt)?
Are you bound by any suretyship agreements?
Administration order?
Debt review/Business rescue?
In community of property?
Present home/business address
Present postal/business address
(if different from home address)
Future postal address
Email address Designation
Telephone number (Home)
Your main bank
Account held in the name of
Account type
How will you pay the monthly bond payments?
Telephone number (Work)
Contact person
Branch
Account number
Cellphone number
Initials First name
Gender
Identity
type
Identity
number
Are you a permanent resident?
Country of
citizenship
Suburb
Suburb
Suburb
*Joint account *Company *Close Corporation *Trust
Section A
Married Single Divorced Other (please specify)
Date you were rehabilitated
(no longer bankrupt or insolvent) if it applies (YYYY-MM-DD)
If yes, for what is the
suretyship agreement R
On account of
Debit order Direct from salary by employer
Postal code
Postal code
Postal code
The Standard Bank of South Africa Limited (Reg. No. 1962/000738/06) An authorised nancial services and registered credit provider (NCRCP15). Page 1 of 5
Marital status
Marital type
Number of dependants (include spouse if unemployed)
Yes No Yes No
Yes No Yes No
Yes No
Yes No
Yes No
Yes No
Home language Language in which we must write to you
Highest qualication
Ethnic group
Doctorate/Masters
Black White Coloured
English Afrikaans
Indian
School leaver Degree Diploma Other (please specify)
Other (please specify)
00141516 2013-07

Income and expenses
Loan details
Reason for the loan
Existing Home Loan/Liberator account/Business Mortgage
Debit order details (if different from the Bank details provided)
Employment details
Section B
Section C
Loan you need
Contract/Purchase price
Attorney doing transfer
Bond amount we must register
Loan term years
Purchase date (YYYY-MM-DD)
Contact internal name Contact details
Bond to be registered
in the name of
Are you buying a home for the rst time?
Do you have an existing home loan account?
Home loan account number
If yes, do you want to add costs to your loan?
(for JumpStart only)
Buy an existing home Build a new home Home improvements Buy vacant land
Other (please specify)
Bank where your existing
home loan account is held
Existing Loan amount R
00141516 2013-07 Page 2 of 5
Your main bank
Account type
How will you pay the monthly bond payments?
Branch
Account number
Debit order Direct from salary by employer
Business name
Business type
Nature of business
Business email
Describe purpose of loan
Registration number
Gross turnover R
R
R
R
Yes No
Yes No
Yes No
*Foot notes (expenses)
1 Exclude current bond if this loan will replace a current home
loan
2 Exclude payment of the loan you are applying for
3 Further-Advance loan: Exclude current and new payment on
the current home loan
Gross (total) income R
Other veriable income R
Total monthly income R
*Total monthly expenses
(include deductions on payslip) R
Money you have available for loan repayment R
If self-employed, how many years (YY)
Occupation
Nature of employment
Other
(please specify)
Current employment type
Permanent Self-employed Retired Unemployed
Employer name
Email address
Time with present employer (YY-MM) Time with previous employer (YY-MM)
Previous employer name
(if less than three years with current employer)
Employer telephone number
Previous employer telephone number
Employer street address
Registered business address
Postal code
Postal code
How are you paid? Monthly Weekly
Section A (continued)
Assurance
Property and/or Collateral details
Shareholders, Members, Partners or Trustees (if applicable)
Improvements to be carried out
Section C (continued)
Interest % Full names Full residency Bank account details
%
%
%
%
%
%
%
%
Section D - Business Mortgage only
00141516 2013-07 Page 3 of 5
Would you require credit life cover? If no may a Financial Consultant contact you?
Main home
House
Second home
Sectional title
Investment or rental
Vacant land
Commercial
Small holding
Property use
Property type
Other (please specify)
Freehold Leasehold Single residential unit
If sectional title, complex name
Unit number
Section number
City or town Stand or erf or lot number
Cellphone number
Cellphone number
Property bonded to
Suburb
Extension number
Who should the assessor contact
to arrange a property valuation
Sellers or contractor name
Name of sellers attorney
Sellers identity number
Street address Postal code
Yes No Yes No
Purchase price R Purchase date (YYYY-MM-DD) Area of land m
2
Total cost R
Name of contractor
Name of architect
Name of quantity surveyor
Date project is to start (YYYY-MM-DD)
Telephone number
Telephone number
Telephone number
Completion date (YYYY-MM-DD)
Have building plans been
approved by local authority
If no, when are they
expected to be approved Yes No
Transaction capability
Debit order details
Financial institution
Account holders signature
Branch
Other, please specify
On which day of the month is the account to be debited (DD)
Account held in the name of
I hereby authorise the bank to credit my Home Loan account and debit the account indicated above for the rst instalment within 30 days of inception or
after issue of nal statement/advice and then monthly thereafter.
Account number
Type of account Current Savings
Section E - Liberator only
00141516 2013-07 Page 4 of 5
Assurance company
Policy type
Policy number
Surrender value (if known) R
Are there any prior cessions or loans against the above policy
(if so, provide details)
Policy details Share Portfolio details
Are any of the above currently pledged as security (if so, provide details)
Attach a listing of shares to be lodged as collateral
Details of Standard Bank transaction account to be linked to Liberator account
I hereby apply for transactional capability on the basis that
1 my Liberator account will be linked electronically to the account indicated above.
2 all instructions given electronically shall be deemed to have been given by me/us and the bank is authorised to give effect to these instructions and to
debit my/our Liberator account with any charges, duties or levies for each transaction.
3 all instructions given to the bank to effect transfers from the Liberator account are to be made in writing unless prior arrangements have been concluded
with the bank.
4 I shall be bound by the terms and conditions contained in the Liberator facility letter.
Account number
MasterCard number
AutoBank card number
Section F
Extra information
Consent
Signature(s)
Section G
I consent to:
Marketing consent
Please ll in information that may affect the Banks decision
As part of our service The Standard Bank of South Africa Limited would like to provide you with information on products and services offered by the group
and other companies, which we believe may benet you.
Because we regard your personal information as condential, we need your consent to share it with the group. The group means our afliates, associates,
subsidiaries and divisions together with our holding company.
I agree that the Bank may enquire about my credit record with any credit reference agencies to consider this credit application or to update my information.
I agree that the Bank may share information with other credit agencies about how I manage this loan agreement during the time of the loan.
The agencies may share this information with other credit providers.
I also agree that the Bank may carry out identity and fraud prevention checks and share information relating to this application with the South African Fraud
Prevention Service.
I agree that I will be responsible for the administration fees and wasted costs that the Bank incurs if I cancel my loan request after the Bank has granted it.
Please note that if you are married in Community of Property, this agreement will be in both you and your spouses names.
I conrm that the information I have given is correct and a true reection of my nancial position and that there is no other information that would affect the
Banks decision to approve the loan.
you marketing your products, services and special offers to me.
you communicating other companies products, services and special offers to me. If I respond positively to such communication,
I may be contacted by that company.
you sharing my personal information within the group for marketing purposes and the group then marketing its products,
services and special offers to me.
you contacting me for research purposes. (The research companies we use follow strict codes of conduct and treat customer
information condentially).
Any outstanding credit applications?
Any bureaus listing that you are disputing?
Is 75% or more of the close corporation, company
or trust, controlled by a non-resident or 75% of its
earnings paid to a non-resident?
*This only applies to a Close Corporation, Company or Trust
If yes, details
If yes, details
If yes, details
Please tick
if applicable
Main applicant
Estate agency name or branch
Contact details
Date (YYYY-MM-DD)
Contact details
Private Banker/Relationship Manager/Consultant/Mobile name
Account executive number
IBT number
Application Branch/Suite name
Personnel number
Home loan
Building loan
One Account Pledge
Vacant land
New loan
[
Switch
Re-advance Further Advance
JumpStart Liberator Business Mortgage
Type of loan
For Bank use only
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
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