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APPLICATION FOR AN INCREASE IN CREDIT LIMIT UNDER AN EXISTING CREDIT
FACILITY IN TERMS OF SECTION 119 (3) OF THE NATIONAL CREDIT ACT

 

NCR Registration Number.

 

New Monthly Limit Applying for :

 

YOUR PERSONAL DETAILS
Title
Initials
Surname
Koopkrag member number
ID Number
 
Residential Address
Postal address
Code
Code
Tel no (H) ( )
Tel no Work ( )
Cell number
E-mail address
 

 

EMPLOYMENT DETAILS
Current Employer
Occupation
Monthly income (excluding allowances) Please attach proof of income :-
MEMBER :
SPOUSE :

 

AFFORDABILITY ASSESSMENT

NETT MONTHLY INCOME
MONTHLY EXPENSES
MEMBER
R
Bond Payments
R
SPOUSE
R
Vehicle Installments
R
Other Income - please specify:-
Credit Card Installments
R
1.
R
Schoolfees
R
2.
R
Short Term Insurance Premiums
R
3.
R
Medical Aid Contributions
R
 
Pension Fund Contributions
R
Policies
R
Groceries
R
Cellular Phone Accounts
R
Telkom Account
R
Rental Expenses
R
DSTV/Mnet
R
Municipal Accounts
R
Fuel
R
Other Expenses
R
TOTAL MONTHLY INCOME
R
TOTAL MONTHLY EXPENDITURE
R

 

ASSETS
LIABILITIES

Registered owner of property

     
Own
CC
 
Trust
Other
     
Registered in the name of
Bond Balance
R
Fixed Property (market value)
R
Loan accounts balance(s)
R
Furniture
R
Bank overdraft balance
R
Vehicles
R
Asset Finance balance
R
Investments
R
Surety
R
Other assets - please specify
Other Credit Facilities - please specify
1.
R
1.
R
2.
R
2.
R
3.
R
3.
R
           
TOTAL ASSET VALUE
R
TOTAL LIABILITIES
R

 

OTHER CREDIT FACILITIES
......Credit Provider
..Account Number
.....Monthly Installments
...Facility granted
1.
R
R
2.
R
R
3.
R
R
4.
R
R

 

CONFIRMATION OF APPLICATION

I/We consent to the Credit Provider checking my/our credit record/s, with any credit reference agency or other credit providers and verify all information supplied on this application form.


I/We hereby warrant that I/we have answered all your questions and request for information fully andtruthfully as part of this assessment process.


I/We hereby confirm that I/we have fully disclosed my/our debt repayment history.
Signed at
this
day of
Signature Member
Signature Spouse (If married in community of property)
(please fill in full name) (please fill in full name)
If under administation, consent by administrator:
 

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