APPLICATION FORM

{"field11":[""],"field11_icon":"no-icon","field7":"Mr","field9":[""],"field9_icon":"no-icon","field8":[""],"field8_icon":"no-icon","field10":[""],"field10_icon":"no-icon","field44":[""],"field44_icon":"no-icon","field15":[""],"field15_icon":"no-icon","field16":"","field12":[""],"field12_icon":"no-icon","field36":[""],"field36_icon":"no-icon","field13":[""],"field13_icon":"no-icon","field14":[""],"field14_icon":"no-icon","field23":"Permanent","field45":[""],"field45_icon":"no-icon","field42":"","field18":[""],"field18_icon":"no-icon","field38":[""],"field38_icon":"no-icon","field46":[""],"field46_icon":"no-icon","field24":"Monthly","field39":"1","field31":"Yes","field48":"Yes","field4":[""],"field4_icon":"no-icon","field49":[""],"field49_icon":"no-icon","field26":"Absa","field51":"Select Option","field50":[""],"field50_icon":"no-icon","field57":"01. I the undersigned hereby give permission that I may be scored by various credit providers.\r\n\r\n02. To consider my application the Financial Services Provider may obtain information from a credit bureau. (Credit Bureau’s supply banks and other parties with credit profiles and credit scores about persons to help them determine if a person is credit worthy.)\r\n\r\n03. Information about how I conduct my account and overdraft facility may be given to and used by any other division of the bank or credit bureau.\r\n\r\n04. The information I have given the bank on these forms is true and accurate.\r\n\r\n05. I hereby authorise Pronto Loans T\/A Loans for SA to issue and deliver payment instructions to their Banker for collection against my above mentioned account at my above mentioned Bank (or any other bank or branch to which I may transfer my account) on the date my salary is deposited into my account on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the Agreement and commencing as soon as this application has been submitted by me and continuing until this Authority and Mandate is terminated by me by giving you notice in writing of not less than 20 ordinary working days. The individual payment instructions of R249 so authorised to be issued must be issued and delivered as a once off payment\r\n\r\nThe individual payment instructions of R79 so authorised to be issued must be issued and delivered on a continuous monthly basis in order to receive immediate access to the value added service package\r\n\r\n06.This authority and mandate has been given electronically in terms of the electronic communications and transactions Act 25 of 2002, Chapter 3, Part 1.If there are insufficient funds in my account to meet the obligation, you are entitled to track my account and represent the instruction for payment as soon as sufficient funds are available in my account. \r\n\r\nI understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my bank statement. Such will contain a reference, PRONTO, which will be included in the said payment instruction and if provided to me should enable me to identify the Agreement.\r\n\r\nB. Mandate\r\nI acknowledge that all payment instructions issued by Pronto Loans T\/A Loans for SA shall be treated by my above mentioned Bank as if the instructions have been issued by me personally.\r\n\r\nC. Cancellation\r\nI agree that although this Authority and Mandate may be cancelled by me, such cancellation will not cancel the Agreement. I shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.\r\n\r\nThe once off amount of R249 will be deducted regardless of the outcome of your loan application","field68":"","field52":"","field63":[""],"field63_icon":"no-icon","field66":"By completing the above with your full names and surname you agree that this serves as a legal electronic signature and acceptance of the aforementioned debit order mandate, and terms and conditions.","field69":"","field34_name":"center"}

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1 Step 1

ID Number

First Name

Surname

Cell Number

Home Phone No

Work Phone No

Email Addressa valid email

Home AddressLine 1

SuburbLine 2

Town/CityLine 3

Postal CodeLine 4

Company Name

Employment Date

Gross Salary

Net Salary

Monthly Expenses

Required Loan Amount (R)

Purpose

Account Number

I AUTHORISE THE BELOW DEBIT ORDER MANDATE AND ACCEPT THE TERMS & CONDITIONS:

I AcceptDecline

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Terms and Conditions

Name and SurnameElectronic Signature

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In case of cancellation as a result of breach on the part of the applicant/client, the remaining balance shall become immediately due and owing to Loans For SA. In the event Loans For SA should hand the applicant/client over for collection of any amounts owing to Loans For SA , Loans For SA shall impose an administration cost of 25% (Twenty Five Percent) added to the outstanding amount owing by the applicant/client to Loans For SA. .All legal fees associated with the collection of monies owing to Loans For SA in terms of these policies, being it for breach or otherwise shall be paid by, or be liable by the applicant/client on an attorney and client scale.