97 van Riebeeck Avenue, Edenvale, Johannesburg Telephone: 011 974 0212 • Facsimile: 086-672-0351 service@kolevmotors.co.za • finance@kolevmotors.co.za accounts@kolevmotors.co.za • sales@kolevmotors.co.za Website: www.kolevmotors.co.za Kolev Motors is an authorised financial services provider in terms of the FAIS Act - Licence no. 31528.

APPLICANT TYPE:

Individual Applicant Sole Proprietor Surety/Co-DebtorID/Passport No.Citizenship: SA Other (If not SA resident, state country of residence)

Country of Residence: Permit Type:Permit No: Permit Exp. Date: DD/mm/yy

Country Issued:Issued Date: DD/mm/yy Expiry Date: DD/mm/yy

Surety ID No. (If appl.)

TRANSACTION TYPE: Instalment Sale Lease RentalLANGUAGE: E    A    Other ETHNIC GROUP:A I   C W

Title: Initials:Surname:First Name: Middle Name:

Gender: M F Graduate: Y  NTrading as/ Name:Tax No. Vat No.Home Tel No. Cell No.Email AddressHome Address: (yrs )

Suburb    Postal Code

Postal Address (If different from Residential)

Suburb    Postal CodePrevious Home Address (y rs mnths )

Suburb    Postal Code

APPLICANTS DETAILS:

mnths

EMPLOYMENT DETAILS: (y rs mnths )

NameAddress

Suburb    Postal CodeBus. Tel No.      Fax No.Type of Industry     Employee No.:Emp. Contact No.  Occupation:

PREVIOUS EMPLOYMENT DETAILS: (yrs mnths )

NameAddressSuburb    Postal CodeBus. Tel No.      Fax No.Type of Industry     Employee No.:

Emp. Contact No.  Occupation:

Do you own your Property? Y N(If yes) In your name Spouse’s Both

Property Type: House Townhouse FlatErf No. SuburbBond/ Rental Payment per month:     RBond Amount Outstanding:   RPurchase Price: R

Current Value:      R

If a Flexi/access Bond, total facility granted? R

Bank Bond Holder:

HOME OWNERSHIP

Know Your Client (KYC): Face to Face On-SiteFace to Face Off-Site Remote-Other

DEALER CODEOriginating Branch: Input Branch:Credit Provider Introducing Branch:marketer’s Code:

marketer’s Name:Marketer’s ID No.   Fax No. Lead Provider:Lead Provider’s ID No.

MARITAL STATUS: S M D W No. of dependants

Date married: DD/mm/yy ANC COP Other

First Name:Surname:  Income RSpouse ID No./DOBSpouse Employer Name:Spouse Employer Address:Suburb    Postal Code

(Nearest relative in SA not Living with you)

Relationship: Contact No. Surname:First Name:Relative’s Address:

Suburb    Postal CodeLandlords Details (Name & Address of Landlord where goods will be kept)

Landlords Name/Landlord’s Address:

Suburb    Postal Code

Spouse Details:

Relatives Details:

BANKING DETAILS

Account Type: Cheque Savings TransmissionBank Name: Branch CodeAccount No.Account Holder Name:

(If appl.) Overdraft Bal.: R Limit: RCredit Card Company:Credit Card No.:Cr. Facility Bal: Straight R Budget RCr. Facility Limit: Straight R Budget R

Existing & / or a previous Account with this Credit ProviderBranch No.:Account No.:Account NameInstalment Amount per month R:Number of Instalments: Current Paid Up To be Settled

Existing accounts with other Credit ProviderName of CompanyAccount No.Instalment Amount per month R:Current Paid Up To be Settled

Name of CompanyAccount NoInstalment Amount per month R:Current Paid Up To be Settled

Please note ALL red sections below are required to be filled in - if you don't see red blocks below, save the file to your computer and then open it to edit it

1

97 van Riebeeck Avenue, Edenvale • Tel: 011-974-0212 Fax: 086-672-0351 • service@kolevmotors.co.za finance@kolevmotors.co.za • accounts@kolevmotors.co.za sales@kolevmotors.co.za • www.kolevmotors.co.za

Kolev Motors is an authorised financial services provider in terms of the FAIS Act - Licence no. 31528

2

Individual Applicant Sole Proprietor Surety/Co-Debtor

TRANSACTION DETAILS: Goods Description

Year Model SalesmanDealer Name  Dealer Tel No. Scheme Code  Buying codem&m Code Period of Contract (mnths)

Special Requirements:Balloon Payment: %   R

Residual Value: %  R

Purpose of goods Business Private Taxi Commerce

Payment Frequency Month Bi Ann Quart Annual

Payment Mode Advance Arrears Cash Debit Order

APPLICANTS FINANCIAL DETAILSProposed Rate % Fixed LinkedSelling Price (VAT inclusive) Extras Description:

Total ExtrasDealer VAPS Description:

Delivery FeeInitial Fuelling ChargesLicense and Registration CostsInitiation fees to be financed? Y NLess Deposit/Initial RentalSource of DepositTotal

ID passport No.

Applicants Income DetailsGross RemunerationMonthly CommissionCar Allowance Included in GrossNet Take-home PayIncome other than Salary/WagesSource of Income

Total Monthly IncomeApplicant’s Expenses per month:Bond Payment/ RentRates/ Water ElectricityVehicle Instalment (excluding those to be settled)

Personal Loan RepaymentsCredit Card RepaymentsFurniture AccountsClothing AccountsOverdraft RepaymentsPolicy/ Insurance RepaymentsTelephone PaymentTransport costsFood and EntertainmentEducation CostsmaintenanceHousehold expensesOther

Total Monthly ExpensesApplicants Disposable Income

Date Remuneration Received: DD/mm/yy

Are you currently liable as: Surety Guarantor Co-DebtorSpecify Details

Insurance Bank VAPSInSale / Lease – Inside Act Rental Outside ActCredit Life Monthly Credit Life Monthly Term Service & Maintenance TermCover Plus   Monthly Cover Plus Monthly Annual Term Extended Warranty  TermExtended Warranty Term Motor Comprehensive Monthly Annual OtherOther Courtesy Car Annual

Comprehensive Vehicle Insurance Y N Policy No. Monthly Annual

Existing Ins. Co Name: Tel No.: Broker Name Tel No.:

Please answer YES or NOAre you a minor? Have you ever been declared mentally unfit by a court?Are you subject to or under administration order or debt review?To the best of your knowledge, are you on ITC or have you been black listed?Have you previously applied for debt re-arrangement?Are you under sequestration?Do you have applications pending for credit, or open quotations for any other vehicle?If so please state

If any of the above is incorrect, state which and give details:

1.  I would like to be included in any Telemarketing campaign2. I would like to be included in any marketing list that you may sell or distribute3. I would like to be included in any mass distribution of emails or specials

I understand that I will be liable for any monthly service fee.I herby consent to this credit provider making enquiries regarding my credit history with any credit bureauI consent to this credit provider reporting the conclusion of any credit agreement with me to the national Loans register in compliance with this credit pro-vider’s obligation under the National Credit ActI herby declare that the information provided by me is true and correct

Signature of Applicant: Date: DD/mm/yy Sales Person

RRRRRRRRRRRR

R

R

RRRRRRR

RRRRRRRRRRRRRRRRRR

Y NY NY N

Monthly