Sales Location Dealer

Date of Birth

D D M Y Y Y YM

Title Full name/s

Cell no Work no Home no

E-mail

ID Number Teljoy Account Nr (in case of existing customers)

Marital Status No. of dependantsContract

ANC COP* Traditional

Physical address

Code

Postal address

Code

Residence Type (house, flat, etc) Years at Current address

Surname

Credit Application

Unit 18, Mifa Park, George Road, Midrand,Private Bag X67, Halfway House, 1685

Tel: +27 011 357-5000Fax: +27 011 357-5210Toll Free: 0860 835569

info@teljoy.co.zagreencredit@teljoy.co.zawww.teljoy.co.za

Registered Name: Film Fun Holdings (Pty) LtdRegistration Number: 1971/009784/07Trading as: TeljoyNCR Number: NCRCP 2801

Note: Where married in COP, this form needs to be signed by both spouses. Where applying together with your spouse, a separate application needs to be completed by him/ her in order to perform a credit and affordability check your combined profiles.

*

BondedInstallation Address if different to Residential Address

Code

Total Cost of Asset (Rand) Amount of Finance Required I can provide additional surety:

Spouse cell no Spouse e-mail

Title Spouse Name & Surname

Occupation

Employer Employee Nr.

HR Contact

Start Date

Branch

Employment

Spouse ID Number Spouse Employer

Account number

Branch name

Note: When payment is effected by any other method than by debit order, an administration fee of R12 excl VAT is applicable.

Name of bank

Branch code

Name of account holder

Type of account

Current/Cheque Savings

Landlord Name & Surname

Contact number E-mail address

I/we hereby instruct and authorize you to draw against my/our Current/Transmission/Savings account with the aforementioned bankall amounts which are due and payable by me in terms of Teljoy’s standard terms and conditions of the agreement. I/we acknowledge that this authority may be ceded or assigned to a third party if the agreement is also ceded or assigned to that third partybut in the absence of such assignment of the agreement to a third party and mandate cannot be assigned to any third party

Full Time Part Time Temp Contract Unempl. Self-empl.

1.

Surname

Cell No

Work No

Name/s

Relationship

2.

Surname

Cell No

Work No

Name/s

Relationship

No thanksVia smsVia e-mail

11. SUPPORTING DOCUMENTS

Would you like to receive information regarding Teljoy products and promotions?

I agree to receive correspondence via e-mail and not post

I agree to debit order payment instruction only

I agree to only receive communication only via English or Afrikaans (Section 129 NCS 2005)

I declare that I have not applied for and/or are not currently under Administration

I declare that I have not applied for and/or are not currently under Debt Review

I consent to Teljoy making inquiries about my credit record with any third party

I consent to identity & fraud prevention checks and sharing information to SA Fraud Prevention Service

I consent to being contacted for service feedback and/or information about other products and services

• Completed application forms (attached)

• Copy of ID

• Proof of income (latest one)

• Latest 3 months bank statements (with latest salary and 2 other salary deposits)

• Proof of address (not older than 3 months)

I declare that the above information is both true and that, together with other information, this will be used to determine whether I can afford the deduction of the loan applied for. This loan is subject to approval and may be accepted or rejected by Teljoy in its sole and

absolute discretion.

PLEASE TICK ALL OF THE BELOW BOXES

SIGNED AT:

APPLICANTFULL NAMES:

*SPOUSE FULL NAMES:

DATE:

APPLICANTSIGNATURE:

*SPOUSE SIGNATURE:

*Where married CoP, spouse also needs to sign this application form and hereby authorities Teljoy to perform a credit check on his/her profile

TOTAL INDIVIDUAL INCOME:

Gross salary (as per payslip)

Overtime and commissions

Court orders (incl garnishee & maintenance deductions)

Less: Deductions on payslip

Net salary (as per payslip)

OTHER MONTHLY INCOME (as per bank statements)

Maintenance from spouse

Rental income

Other income - Specify source below:

Rental (housing)

Rates and Taxes / Lights and Water

Levy and Security

Telephone (home and cell)

Transport costs

School Fees

Food / Groceries

Medical fees

Insurance (Life)

Insurance (Short Term)

Maintenance / Court order to spouse

Clothing (not on account)

Entertainment

Other expenses

TOTAL EXPENSES:

Monthly income and expenses declaration

PLEASE CONSENT TO THE FOLLOWING:

TOTAL:

Vehicle Finance Agreements Installment Amount Balance Outstanding (RANDS ONLY)

Credit Cards / Store Credit Cards Installment Amount Balance Outstanding (RANDS ONLY)

Personal Loan(s) / Other debt obligations Installment Amount Balance Outstanding (RANDS ONLY)

SIGNED AT:

FULL NAMES:

DATE:

CLIENT SIGNATURE:

I consent for the upfront initial fee to be financed with the principal debt?

Home Loan(s) Installment Amount Balance Outstanding (RANDS ONLY)