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    PERSONAL INFORMATION
    Please provide us with the following personal details.








    VEHICLE INFORMATION














    Please Upload the Follow Photo's of your Car:
    Front:

    Back:

    Left Side:

    Right Side:

    Interior:

    Service Book:

    DECLARATION BY THE CLIENT
    I confirm that:

    I am not a minor.
    I have never been declared mentally unfit by a court.
    I confirm that I am not blacklisted.
    I am not subject to an administration order.
    I do not have any current application pending for debt restructuring or alleviation.
    I do not have any current debt re-arrangement existence.
    I have not previously applied for debt re-arrangement.
    I am not under sequestration.
    I do not have applications pending for credit card, nor open quotations as envisaged in section 92 of the National Credit Card Act.
    I hereby give consent to the credit Provider to make inquiries about my credit record with any credit agency and to obtain whatever information on me they might require to process the credit card application and/or application for insurance and to share my payment behavior with any credit card agency.

    I hereby agree that all of the above information is true and correct.