Upfront Checklist New - and Final Document

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UPFRONT CHECKLIST

Merchant number: 1897587


CUSTOMER INFORMATION
LOAN AMOUNT / PRODUCT PRICE
R
Customer ID

Customer titles (x)


MR MRS MISS Ms

Customer First Names.

Surname.

Marital Status (x) Work Number Banking Cell Number


Single Married

Business Language Preferred language

Is the customer or spouse if married in COP Please mark with X


YES NO
SPOUSE DETAILS IF MARRIED IN COP
ID Number Surname Name Spouse Tel Number Address

Under Insolvency Administration Under Curator Ship Busy with dept Counselling

Applicant Residential Address

How is the customer employed(permanent, contract etc)


Employer Name Date of Employment Employer Address

Employer Address

Bank Name Branch Code Bank Account Number

Paid Weekly Paid Monthly Net Salary

MONTHLY EXPENCES
Transport Rent Food
R R R
NB: The system will request for all supporting documentation which to be submitted together with the Pre-agreement quote and
application forms once application is preapproved.REG NO: 2010/106386/23 6A Villa Barcelona,
Albertvilee 2195 M.D Easy Mulibane; F.D Takalani Mbedzi. Est 2010 Accredited FSP (Financial Service Provider) Registered
with the Compensation Fund, NHBRC & CIDB (Construction Industry Development Board) 083 5115 228 www.ketce.com

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