Loan Application | Koopkrag Application

MEMBER PERSONAL DETAILS

Require fields marked with *

Member Number

Member Title

Spouse Title

Member Name + Surname *

Spouse Full Names

Member Identification Number *Please enter a valid 13-digits South African ID number0 / 13

Spouse Identification NumberPlease enter a valid 13-digits South African ID number0 / 13

Mobile *

Spouse Mobile

Email

Spouse Email

Street Address *

PO Box

Suburb *

Suburb

City *

City

Province *

Province

Postal Code *

Postal Code

Member Employment Bases *

Spouse Employment Bases

Member Occupation *If pensioner, please write 'Pensioner'

Spouse OccupationIf pensioner, please write 'Pensioner'

Employer *If pensioner, please write 'Pensioner'

Spouse EmployerIf pensioner, please write 'Pensioner'

Maritial Status

AFFORDABILITY ASSESSMENT

Require fields marked with *

Monthly Income

Gross Salary - Applicant *

ZAR

Gross Salary - Spouse

ZAR

Other Income - Applicant

ZAR

Other Income - Spouse

ZAR

Please specify

Total Income - Applicant

Total Income - Spouse

Payslip Deductions

Medical Aid - Applicant

ZAR

Medical Aid - Spouse

ZAR

Pension / Provident Fund - Applicant

ZAR

Pension / Provident Fund - Spouse

ZAR

PAYE - Applicant

ZAR

PAYE - Spouse

ZAR

UIF - Applicant

ZAR

UIF - Spouse

ZAR

Other Deductions - Applicant

ZAR

Other Deductions - Spouse

ZAR

Total Deductions - Applicant

Total Deductions - Spouse

Net Salary - Application

Net Salary - Spouse

Monthly Expenses

Accommodation Expense - Applicant

ZAR

Accommodation Expense - Spouse

ZAR

Transport Expense - Applicant

ZAR

Transport Expense - Spouse

ZAR

Food Expense - Applicant

ZAR

Food Expense - Spouse

ZAR

Education Expense - Applicant

ZAR

Education Expense - Spouse

ZAR

Medical Expense - Applicant

ZAR

Medical Expense - Spouse

ZAR

Maintenance Expense - Applicant

ZAR

Maintenance Expense - Spouse

ZAR

Water & Electricity - Applicant

ZAR

Water & Electricity - Spouse

ZAR

Other Expenses - Applicant

ZAR

Other Expense - Spouse

ZAR

Total Expenses - Applicant

Total Expenses - Spouse

Accounts

Asset Finance - Applicant

ZAR

Asset Finance - Spouse

ZAR

Personal Loans - Applicant

ZAR

Personal Loans - Spouse

ZAR

Credit Cards - Applicant

ZAR

Credit Cards - Spouse

ZAR

Bond Repayments - Applicant

ZAR

Bond Repayments - Spouse

ZAR

Cellphone Expense - Applicant

ZAR

Cellphone Expense - Spouse

ZAR

Micro Loans - Applicant

ZAR

Micro Loans - Spouse

ZAR

Security - Applicant

ZAR

Security - Spouse

ZAR

Insurance - Applicant

ZAR

Insurance - Spouse

ZAR

Clothing - Applicant

ZAR

Clothing - Spouse

ZAR

General Retail - Applicant

ZAR

General Retail - Spouse

ZAR

Total Accounts - Applicant

Total Accounts - Spouse

Min Bond Repayment - Applicant

ZAR

Min Bond Repayment - Spouse

ZAR

Disposable Income

Disposable Income Total - Applicant

Disposable Income Total - Spouse

ASSETS & LIABILITIES

If applicable

Assets

Liabilities

Registered Owner of Property

Bond Balance

ZAR

Registered in the name of

Loan Account Balance

ZAR

Fixed Property Market Value

ZAR

Bank Overdraft Balance

ZAR

Furniture

ZAR

Asset Finance Balance

ZAR

Vehicles

ZAR

Surety

ZAR

Other Assets

ZAR

E.g. Investments

Other Liabilities

ZAR

Total Assets

Total Liabilities

REFERENCES

Two Relatives - Not residing with you

Where did you hear about Koopkrag for the first time? *

First Reference Title *

Second Reference Title *

First Reference Initials *

Second Reference Initials *

First Reference Surname *

Second Reference Surname *

First Reference Residential Address *

Second Reference Residential Address

Mobile *

Alternative Number

Relationship

CONSENT AND SUBMISSION

Please complete where applicable

Bank Details for Transfer of the Loan

Bank Name *

Branch Number

Account Holder Name *

Account Number *

Account Type *

Credit Facility Application

Asset Finance

Repayment Period (months)Period in months

Amount (applying for)

Description of Item

Short Term / Personal Loan

Repayment Period (months)Period in months

Amount (applying for)

Reason for Personal Loan

Credit Application Declaration

Are you or have you ever been declared mentally unfit by a High Court in South Africa? * *YesNo

Are you insolvent or is there any indication that your estate could be placed under provisional sequestration? *YesNo

Are you currently under or have you ever applied for a debt review? *YesNo

Do you have a re-arranged agreement in place with any credit provider as a result of debt counseling? *YesNo

Do you have any dispute in process with a Credit Bureau? *YesNo

Are you currently under an administration order in terms of section 74(1) of the Magistrate's Court Act? *YesNo

Please upload ID Document *

Please upload Proof of Residence *

Please upload Proof of Income (Latest Payslip and Bank statements) *

Please attach your Latest Payslip and 3 months bank statements

Signed at *

Date *

Date application completed

Applicant's Signature *

Spouse Signature

If applicable

Save as Draft

Koopkrag Credit/Loan Application

MEMBER PERSONAL DETAILS

Require fields marked with *