Koopkrag Limit Increase Application MEMBER PERSONAL DETAILSRequire fields marked with *Member NumberMember TitleSpouse TitleMember Full NamesSpouse Full NamesMember Identification Number *Please enter a valid 13-digits South African ID number0 / 13Spouse Identification NumberPlease enter a valid 13-digits South African ID number0 / 13MobileSpouse MobileEmail *Spouse EmailStreet AddressPO BoxSuburbSuburbCityCityProvinceProvincePostal CodePostal CodeLanguageAfrikaansEnglishOtherMarital StatusMarried - by antenuptial contractMarried - in community of propertyWidow / WidowerUnmarriedDivorcedCommon LawMember Employment BasesPlease selectPermanentSelf-EmploymentContractedCommission EarnerPensionerSpouse Employment BasesPlease selectPermanentSelf-EmploymentContractedCommission EarnerPensionerMember OccupationIf pensioner, please write 'Pensioner'Spouse OccupationIf pensioner, please write 'Pensioner'EmployerIf pensioner, please write 'Pensioner'Spouse EmployerIf pensioner, please write 'Pensioner'Work AddressAFFORDABILITY ASSESSMENTRequire fields marked with *Monthly IncomeGross Salary - ApplicantZARGross Salary - SpouseZAROther Income - ApplicantZAROther Income - SpouseZARPlease specifyPlease specifyTotal Income - ApplicantTotal Income - SpousePayslip DeductionsMedical Aid - ApplicantZARMedical Aid - SpouseZARPension / Provident Fund - ApplicantZARPension / Provident Fund - SpouseZARPAYE - ApplicantZARPAYE - SpouseZARUIF - ApplicantZARUIF - SpouseZAROther Deductions - ApplicantZAROther Deductions - SpouseZARTotal Deductions - ApplicantTotal Deductions - SpouseNet Salary - ApplicationNet Salary - SpouseMonthly ExpensesAccommodation Expense - ApplicantZARAccommodation Expense - SpouseZARTransport Expense - ApplicantZARTransport Expense - SpouseZARFood Expense - ApplicantZARFood Expense - SpouseZAREducation Expense - ApplicantZAREducation Expense - SpouseZARMedical Expense - ApplicantZARMedical Expense - SpouseZARMaintenance Expense - ApplicantZARMaintenance Expense - SpouseZARWater & Electricity - ApplicantZARWater & Electricity - SpouseZAROther Expenses - ApplicantZAROther Expense - SpouseZARTotal Expenses - ApplicantTotal Expenses - SpouseAccountsAsset Finance - ApplicantZARAsset Finance - SpouseZARPersonal Loans - ApplicantZARPersonal Loans - SpouseZARCredit Cards - ApplicantZARCredit Cards - SpouseZARBond Repayments - ApplicantZARBond Repayments - SpouseZARCellphone Expense - ApplicantZARCellphone Expense - SpouseZARMicro Loans - ApplicantZARMicro Loans - SpouseZARSecurity - ApplicantZARSecurity - SpouseZARInsurance - ApplicantZARInsurance - SpouseZARClothing - ApplicantZARClothing - SpouseZARGeneral Retail - ApplicantZARGeneral Retail - SpouseZARTotal Accounts - ApplicantTotal Accounts - SpouseMin Bond Repayment - ApplicantZARMin Bond Repayment - SpouseZARDisposable IncomeDisposable Income Total - ApplicantDisposable Income Total - SpouseASSETS & LIABILITIESIf applicableAssetsLiabilitiesRegistered Owner of PropertyYesNoBond BalanceZARRegistered in the name ofLoan Account BalanceZARFixed Property Market ValueZARBank Overdraft BalanceZARFurnitureZARAsset Finance BalanceZARVehiclesZARSuretyZAROther AssetsZARE.g. InvestmentsOther LiabilitiesZARTotal AssetsTotal LiabilitiesCONSENT AND SUBMISSIONPlease complete where applicablePurchase Limit and/or Budget LimitCurrent Purchase LimitCurrent Budget LimitNew Purchase Limit RequestedApplying forNew Budget Limit RequestedApplying forDebit Order(If applicable)Bank NameBranch NumberAccount Holder NameAccount NumberAccount TypeDate of Debit Order27th28th1st2ndSignatureStart signing your signature hereYour browser does not support e-Signature field.CONSUMER DECLARATIONAre you or have you ever been declared mentally unfit by a High Court in South Africa? *YesNoAre you insolvent or is there any indication that your estate could be placed under provisional sequestration?YesNoAre you currently under or have you ever applied for a debt review?YesNoDo you have a re-arranged agreement in place with any credit provider as a result of debt counseling?YesNoDo you have any dispute in process with a Credit Bureau?YesNoAre you currently under an administration order in terms of section 74(1) of the Magistrate's Court Act?YesNoTerms and ConditionsYes, I agree with the privacy policy and terms and conditions. Cost of CreditI agree with the membership fees as per the Cost of CreditPlease upload ID DocumentDrag and Drop (or) Choose FilesPlease upload Proof of ResidenceDrag and Drop (or) Choose FilesPlease upload Proof of Income (Latest Payslip and Bank statements)Drag and Drop (or) Choose FilesPlease attach your Latest Payslip and 3 months bank statementsSigned atDateDate application completedApplicant's SignatureStart signing your signature hereYour browser does not support e-Signature field.Spouse SignatureStart signing your signature hereYour browser does not support e-Signature field.If applicableSubmitSave as Draft
