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Customer Care

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Online Application

  • Personal Information
  • Income & Salary Deductions
  • Basic Essential Needs / Monthly Commitments
  • Debt Obligations
  • Other Personal Details
  • Particulars of Moveable Property

Personal Information

Date of Birth



Employer Information / Work Details



Spouse Details

Income & Salary Deductions

Should you be married (ANC or COP or Per Contract)
Incomes and deductions needed of both

As per Salary Advice



INCOME Yourself Spouse
Gross Salary
Nett Salary
Other Income
 
Deductions (Yourself)
Tax
Medical Aid
Uif
Pension
Insurance Policies
Other Deductions 1.
2.
3.
 
Deductions (Spouse / Partner)
Tax
Medical Aid
Uif
Pension
Insurance Policies
Other Deductions 1.
2.
3.

Basic Essential Needs / Monthly Commitments

COMMITMENT VALUE
Food:
Chronic Medication
School Fees: Child 1
Child 2
Child 3
After School Care: Child 1
Child 2
Child 3
Cellphone Contract
Cellphone Prepaid
Short Term Insurance

Other Insurance

Other essential living expenses
Please give details

Other Expenses
Bond Repayment

Debt Obligations

All Outstanding Debts

Other Personal Details

Dependants [Your Parents / Children etc.]
Next of Kin [Not Living at Same Address] [Not a Friend at Work]
Friend at Work [Not a Family Member]

Particulars of Moveable Property

Television

Stove

Washing Machine

Fridge

Bed

Computer

Other Expensive Furniture & Or Equipment


All the above information filled in by the consumer / applicant, and filled to the best of his / her ability. All the information supplied as far as the consumer / applicant knows, to be true and correct.


 

Copyright 2017 PACFIN Financial Solutions. All rights reserved.
Customer Care Line: +27 73 888 2908 · Fax: +27 11 970 1564

Em'Arick Financial Services T/A Pacfin Financial Solutions - Reg. No.2006/148851/23
17 Sonneblom Street; Kempton Park · South Africa