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Please note, in order to ensure accuracy of information captured, South African identity numbers are validated in accordance with criteria set by the Department of Home affairs. All email addresses are also verified to ensure an accurate method of communication, email addresses are not used for any other purpose other than direct consultant to client communication.

All fields marked with and asterisk (*) are mandatory fields, if you have a South African ID then the passport is not mandatory if you do not have a South Afircan ID then the passport field is mandatory.

Please note: This Application for Credit is applicable to On Line Shopping only and cannot be used at any of our Branches.  For Branch Applications, please take your Green Bar Coded ID Document; Latest 3 Months Payslips and Proof of Residence to your nearest Branch, who will gladly assist you in processing this

Application Form

Residential Address Detail

Documents Required

Terms & Conditions

    Please note: This Application for Credit is applicable to On Line Shopping only and cannot be used at any of our Branches. For Branch Applications, please take your Green Bar Coded ID Document; Latest 3 months Payslips and Proof of Residence to your nearest Branch, who will gladly assist you in processing this.


    I hereby certify that the information submitted by me the Consumer and recorded in this request for credit is true and correct in every detail and that I have fully and truthfully answered all the questions in this assessment form Should it be found that I did not fully and truthfully answer any question such conduct would be an absolute defence in favour of the Credit Provider, against a claim of Reckless Granting
    I hereby irrevocably authorise and consent to the Credit Provide remaking reasonable enquiries to confirm any details furnished by me in the request for credit and to access the file of any Credit Bureaux. National Credit Regulator, National Loans Register or any other Registered Data Base to obtain my credit record. and any other information which might be relevant in this assessment, and at any time during the existence of the Credit Agreement should this request for credit be successful and resulting in a Credit Agreement.
    I further consent to. authorise and agree that should this request be successful resulting in a Credit Agreement that the details of the manner in which this account is conducted and repaid will be provided to any Registered Credit Bureaux, National Credit Regulator. National Loans Register or any other Registered Data Base and that any overdue instalments will be reflected on my Credit Record.
    I acknowledge that the information herein contained was procured in accordance with the Law, is adequate, relevant and not excessive and that I gave consent to the processing of my personal information. I further acknowledge that the information was directly collected from myself freely and without any duress. or if collected from a third party, that I have consented thereto.
    I acknowledge that any confidential information given to the Credit Provider was given with the intend of enabling the Credit Provider to access the information only for the purposes for which it was intended
    I acknowledge that whilst applying for credit and completing the request form, that I was requested to produce my identity document and or drivers license if applicable for identification purposes only and that I voluntarily consented to the making of copies thereof.

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