Customer Application Form

CAPITAL BOX ASSET FINANCE APPLICATION FORM

1.) BORROWING ENTITY AND COMPANY DETAILS (WHICH EVER APPLICABLE)

Full Name

ID No/ Registration No/ CK No:

Date Incorporated/ No of years in business:

HPCSA No:

VAT No:

Physical Address:

Postal Code

Postal Address:

Postal Code

Telephone Number:

Website:

Contact Person:

Phone/Mobile

2.) DESCRIPTION AND ACTIVITIES OF BUSINESS INCLUDING MANAGEMENT STRUCTURES AND QUALIFICATIONS

Description and activities of business

3.) FULL NAMES OF SHAREHOLDERS/ MEMBERS/ PARTNERS/ SOLE PROPRIETOR
(WHICH EVER APPLICABLE )

Person 1

Full name:

Identity Number:

Residential Address

Postal Code:

Cell Number

% Held in business:

Marital Status:

Single

Divorced

COP

ANC

House Ownership:

Bonded

Bond-Free

In Your Name

In Spouses Name

Other

Type:

House

Town House

Flat

Other

Would you like add more shareholders?

Yes

Person 2

Full name:

Identity Number:

Residential Address:

Postal Code:

Cell Number:

Email:

% Held in business:

Marital Status:

Single

Divorced

COP

ANC

House Ownership:

Bonded

Bond-Free

In Your Name

In Spouses Name

Other

Type:

House

Town House

Flat

Other

Would you like add more shareholders?

Yes

Person 3

Full name:

Identity Number:

Residential Address:

Postal Code:

Cell Number:

Email:

% Held in business:

Marital Status:

Single

Divorced

COP

ANC

House Ownership:

Bonded

Bond-Free

In Your Name

In Spouses Name

Other

Type:

House

Town House

Flat

Other

Would you like add more shareholders?

Yes

Person 4

Full name:

Identity Number:

Residential Address:

Postal Code:

Cell Number:

Email:

% Held in business:

Marital Status:

Single

Divorced

COP

ANC

House Ownership:

Bonded

Bond-Free

In Your Name

In Spouses Name

Other

Type:

House

Town House

Flat

Other

4.) BANK ACCOUNT DETAILS

Name of Bank:

Account Number:

Branch Code:

Branch Name:

Account Type:

Account Holders Name:

5.) AUDITORS DETAILS (BUSINESS ACCOUNTANTS)

Audit Co Name:

Contact Person:

Telephone Number of Auditors:

Financial Year End:

Last Accounts:

Attach Financial Statements

Choose File

6.) SHORT TERM INSURANCE DETAILS

Insurance Company:

Name of Insurance Broker:

Policy Number:

Telephone Number of Insurance Broker:

7.) PROPERTY DETAILS (IF OWNED BY THE COMPANY OR GROUP COMPANY)

Physical Address:

Postal Code:

Year of Purchase:

Purchase Price:

Outstanding Mortgage:

Market Value:

8.) LANDLORD DETAILS OF LEASED BUSINESS PREMISES (IF APPLICABLE)

Do you have a landlord for leased business premises?

Yes

Landlord Name:

Contact Person:

Postal Address:

Postal Code:

Telephone Number of Landlord:

9.) FINANCIAL FACILITY REQUIREMENTS

Description of Asset:

Attach Quote Of Assest

Choose File

Supplier Name:

Contact Person:

Email:

Telephone Number:

Purchase Price (Incl. VAT)

Settlement Included:

Yes

Settlement Value:

Less Deposit/ Initial Rental (Incl. VAT)

Term:

Amount Required (Incl. VAT):

Annual Turnover:

Gross Asset Value:

10.) ACKNOWLEDGMENT BY CREDIT APPLICANT

Full Name

ID Number

Company

Company Registration Number

I agree that Capital Box Asset Finance (Pty) Ltd, and its associates, funders and cessionary/presumptive cessionary partners (“CBAF”) may share the information provided by the Company with each other and may make inquiries to confirm any information provided by the Company and that CBAF may verify the information and obtain additional information from a registered credit bureau, when assessing the information provided herein. I authorise CBAF to conduct a credit report on the company, and warrant that all the directors and/or members have consented to the Company instructing CBAF to conduct the credit enquiry on the Company and that the Director and/or Members acknowledges that the enquiry will include an inquiry into the Director and/or Member’s credit profile. I further warrant that the Directors and/or members authorise CBAF to obtain the credit information on the Directors and/or Members and that the Company has the consents as stated herein, in writing. In the event of CBAF being required to do an account verification check to verify that banking details provided, are correct, or to enquire with the Company’s banker to obtain its opinion with regards to lending amounts and lending terms applicable to the Company, I hereby authorise such an enquiry. We furthermore consent to CBAF submitting our information, including payment profile and default information and any other relevant information, to a registered credit bureau and to allow a registered credit bureau to release the information for lawful purposes to third parties. I furthermore warrant that all information supplied to CBAF is to the best of my knowledge true and correct, that I am not aware of any other information that would affect the credit application of the Company in any way and that I am authorised to sign this document.

11.) PERMISSION TO OBTAIN CREDIT REFERENCES AND TO MARKET PRODUCTS AND SERVICES

As part of our service Capital Box Asset Finance (Pty) Ltd would like to provide you with information on products and services offered by the group and other companies, which we believe may benefit you. Because we regard your personal information as confidential, we need your consent to share it with the group. The group means our affiliates, associates, subsidiaries and divisions together with our holding company.

12.) MARKETING

I consent to:

You marketing your products, services and special offers to me.

YES

You communicating other companies’ products, services and special offers to me. If I respond positively to such communication, I may be contacted by that company.

YES

You sharing my personal information within the group for marketing purposes and the group then marketing its products, services and special offers to me.

YES

You contacting me for research purposes. (The research companies we use follow strict codes of conduct and treat customer information confidentially).

YES

13.) CONSENT

I/we understand that I/we may be liable for a monthly service fee.
I/we hereby declare that the information provided by me/the enterprise is true and correct.
I/we consent to Capital Box Asset Finance (Pty) Ltd making enquiries about my/the enterprises credit record with credit reference agencies for the purposes of assessing this credit application or updating my information in future.
I/we also consent to Capital Box Asset Finance (Pty) Ltd sharing information with such agencies about how I manage this loan agreement, who may in turn share this information with other credit providers.
I/we also consent to Capital Box Asset Finance (Pty) Ltd sharing information with its funders and/or prospective cessionary partners for the purposes of assessing this credit application.
I/we consent to identity and fraud prevention checks and sharing information relating to this application through the South African Fraud Prevention Service.

14.) GETTING STATEMENT(S)

Capital Box Asset Finance (Pty) Ltd occasionally works with other financial institutions to provide a better service to clients. In these dealings we ensure that all personal and financial information about clients is kept strictly confidential.

Attached Last 3 Months Bank Statements

Choose File

If you are married in community of property you are required to obtain the written consent of your spouse, in terms of the Matrimonial Property Act of 1984, before entering this agreement.

I confirm that the required consent is held; or

I confirm that the required consent is not held.

15.) SIGNATURE

Full Name

ID Number

Company

Company Registration Number

Some description about this section

SIGNATURE OF APPLICANT:

Draw a Signature

Upload a Signature File

DRAW A SIGNATURE

Sign Here

Signature Upload

Choose File

Date / Time

CAPITAL BOX ASSET FINANCE PTY LTD
Reg no: 2021/442788/07 l 22 Molteno Road, Cape Town 8001 l Tel 021 492 9021
Director: M.P. Dowson

CAPITAL BOX ASSET FINANCE APPLICATION FORM

1.) BORROWING ENTITY AND COMPANY DETAILS (WHICH EVER APPLICABLE)

2.) DESCRIPTION AND ACTIVITIES OF BUSINESS INCLUDING MANAGEMENT STRUCTURES AND QUALIFICATIONS

3.) FULL NAMES OF SHAREHOLDERS/ MEMBERS/ PARTNERS/ SOLE PROPRIETOR(WHICH EVER APPLICABLE )

Person 1

Person 2

Person 3

Person 4

4.) BANK ACCOUNT DETAILS

5.) AUDITORS DETAILS (BUSINESS ACCOUNTANTS)

6.) SHORT TERM INSURANCE DETAILS

7.) PROPERTY DETAILS (IF OWNED BY THE COMPANY OR GROUP COMPANY)

8.) LANDLORD DETAILS OF LEASED BUSINESS PREMISES (IF APPLICABLE)

9.) FINANCIAL FACILITY REQUIREMENTS

10.) ACKNOWLEDGMENT BY CREDIT APPLICANT

11.) PERMISSION TO OBTAIN CREDIT REFERENCES AND TO MARKET PRODUCTS AND SERVICES

12.) MARKETING

13.) CONSENT

14.) GETTING STATEMENT(S)

15.) SIGNATURE

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3.) FULL NAMES OF SHAREHOLDERS/ MEMBERS/ PARTNERS/ SOLE PROPRIETOR
(WHICH EVER APPLICABLE )