One-Minute Application

PERSONAL DETAILS
Full Names
Surname
ID/Passport Number
Current Bank
If other, please specify
Work Status
CONTACT DETAILS
Are you a South African Citizen?	Yes No
Residential Address
Town / City
Postal Code
Email Address
Tel No (work)
Tel No (home)
Cell No
Fax No
CREDIT HISTORY (as required in terms of the National Credit Act No 24 of 2005)
Have you ever been declared insolvent or under administration?	Yes No Under administration
Are you currently under debt review?	Yes No
Do you have any debt re-arrangements in place?	Yes No
Do you agree that Mortgage Assist (Pty) Ltd can perform a confidential credit check in order to establish your pre-qualification status?	Yes No
LOAN INFORMATION
Type of application
Type of loan
If other, please specify
Reason for this loan
If other, please specify
Required loan amount
NET SURPLUS INCOME (to determine affordability as required in terms of the National Credit Act No 24 of 2005)
	Self (if applicable)	Co-applicant (if applicable)
Gross monthly income
Net monthly income after deductions
Total monthly expenses
Net surplus income
COMMENTS (please provide any other relevant information to enable us to process your application)