FIRST STEP - PERSONAL DETAILS

Title

Surname

First name - all names in full

ID Number

Loan Type

Short Term = Up to R5000, 6 Months - Suitable for Bad Credit
Personal = From R6000 to R15000, 12-24 Months
Bond = Loan secured by fixed property such as a House

SHORT TERM LOAN DETAILS - 2/4

Loan Amount

Credit History

Loan Purpose

CONTACT DETAILS - 3/4

Work Phone Number - include code

Home Phone Number - include code

Cell Phone Number

ADDRESS

Street:

Suburb:

City/Town:

Province:

Code:

EMPLOYMENT DETAILS - 4/4

Gross Salary - before tax

Net Salary - paid into your bank

Company Name

Department

Salary Pay Date

Employment Status

Payment Frequency

Period Employed
Years Months

PERSONAL LOAN DETAILS - 2/4

Loan Amount

Loan Term

Credit History

Loan Purpose

Do you have a Bank Account?

Own or Joint, with 2 months Salary deposited

Bank Name

CONTACT DETAILS - 3/4

Work Phone Number - include code

Home Phone Number - include code

Cell Phone Number

Preferred Contact Method

ADDRESS

Street:

Suburb:

City/Town:

Province:

Code:

EMPLOYMENT DETAILS - 4/4

Gross Salary - before tax

Net Salary - paid into your bank

Company Name

Department

Salary Pay Date

Employment Status

Payment Frequency

Period Employed
Years Months

BOND DETAILS - 2/4

Loan Amount

Credit History

Loan Purpose

Value of Property Owned (0 for none)

Amount Outstanding on Current Bond (0 for None or New Bond)

Bond Holder

CONTACT DETAILS - 3/4

Work Phone Number - include code

Home Phone Number - include code

Cell Phone Number

ADDRESS

Street:

Suburb:

City/Town:

Province:

Code:

EMPLOYMENT DETAILS - 4/4

Gross Salary - before tax

Net Salary - paid into your bank

Company Name

Department

Salary Pay Date

Employment Status

Payment Frequency

Period Employed
Years Months

Last Step - Confirmation

By submitting this application you agree for us to search the necessary credit reference agencies on yourself and any other named Person (s) on the application and may pass your details to our current lenders. The personal data relating to you, gathered by us in our enquiry, will be recorded electronically and only used in accordance with the Law and our Privacy Policies.

Loan eXpress, and any other broker or lender we refer this application to, may use the information you have provided from this website in connection with your application. Loan eXpress, and any other broker or lender we refer this application to may, use and share your information in order to contact you about both our services and products and those of carefully selected organisations that may be of benefit to you.

I Agree