Form – Intellogroup

hello@intellogroup.co.za

(012) 880 1416
072 3000 268

Mon-Fri 8am-4pm

Facebook Linkedin

Home
Blog
About Us
Services
Contact Us

Appointment

"*" indicates required fields

1Individual Application Form

2Commercial Application Form

3Existing Fleet / Asset Register

4Assets & Liabilities

5Ownership Structure

Personal Details

Title*

Initials*

Surname*

Full First Name*

ID / Passport Number*

Telephone / Landline Number

Cell Number*

Cell Phone Details*

Contract Phone

Prepaid Phone

Email Address*

Citizenship*

South African

Other

Country of Citizenship*

Permit Type*

Permit Number*

Permit Issued Date*

Permit Expiry Date*

Language Preference*

Relative's Details*

(Name and Surname)

Relationship*

Relative's Cell Number*

Ethnic Group*

Marital Status*

Marraige Type*

Date Married*

Day

Month

Year

Home Address*

(Street address)

Suburb*

City / Town*

Postal*

Period at Address*

(Years and months)

Employment Details*

(Company name)

Occupation*

Period at Work*

(Years and months)

Monthly Income / Salary*

Personal Bank Details

Name of Bank*

Account Number*

Account Type*

Name of Account Holder*

Home Ownership

Do You Own Property?*

Yes

Tenant

Lodger

Bond Instalment*

Current Bond Outstanding*

Purchase Price*

Current Property Value*

Bond Holder Name/s*

Consent

I am not a minor*

Yes

I have never been declared mentally unfit by a court*

Yes

I do not have any current debt re-arrangement in existence*

Yes

I do not have any current application pending for debt restructuring or alleviation*

Yes

I am not under sequestration*

Yes

I don’t have applications pending at credit, nor open quotations as envisaged in section 9.2 of the NCA*

Yes

Are you a politically exposed person?*

Yes

If any of the above is incorrect, state which and give details:

Permissions

I would like to be included in any Telemarketing Campaign*

Yes

I would like to be included in any Marketing list that you might sell or distribute*

Yes

I would like to be included in any mass distribution of emails or SMS messages*

Yes

Credit Consent*

I consent

I understand that I will be liable for monthly service fee.
I hereby consent to this Credit provider making enquiries regarding my credit history with any credit bureau.
I consent to this credit provider reporting the conclusion of any credit agreement with me to the National Loans Register in compliance with this Credit Providers obligation under the National Credit Act.
I hereby declare that the information provided by me is true and correct.

*I/we consent to the Credit Provider (the group includes our affiliates, associates, subsidiaries, and divisions, including our holding company) or its cessionary making enquiries about *my/ our credit record with any credit reference agency and credit bureaus and any other party to confirm the details on this application. (*I / We / My / Our / You- any Director / Shareholder / Member / Trustee / Authorised Representative / Partner / Spouse / Related Party)

This Credit Provider or its cessionary may also provide credit reference agencies and credit bureaus with regular updates regarding how I/we manage my/our account, including my/our failure to meet agreed terms and conditions.

I/we consent that credit reference agencies and credit bureaus may, in turn, make the records and details available to other credit grantors. The Credit Provider or its cessionary may also give this information to any person who in its opinion, needs it to carry out any of the Credit Provider or its cessionary rights or duties in terms of the contract or any law pertaining to the products I/we have requested.

I/we hereby give this Credit Provider or its cessionary permission to carry out identity and fraud prev ention checks on me/us and to share the information provided in this application with the South African Fraud Prevention Service. I certify that the above details are true and correct. We would like to provide you, your directors, and/or shareholders (“*you”) with information on products and services offered by the Credit Provider, and by your signature hereto, you hereby consent to the Credit Provider to market to you our products and services, the sharing of personal information within the group for marketing purposes, and the group then marketing its products and services to you.

I/we consent to the Credit Provider, processing the required personnel information, as provided above and acknowledge that I understand the purposes of which it is required and for which it will be used. I/We, the undersigned, hereby declare that the information provided herein is both true and correct, in every aspect and represents a true reflection of my personal, and in the event of a juristic person, its financial position.

CONSENT TO PROCESS PERSONAL INFORMATION IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT NO. 4 OF 2013 (POPI)

In terms of POPI, The Credit Provider is required to process your / your company’s Personal Information in a lawful and reasonable manner. INFORMATION REQUIRED: The Credit Provider requires the following personal information: Registration documentation in respect of the company / close corporation / trust (in the event of a trust (or shareholding constituting of a trust), a copy of the trust deed and list of beneficiaries and clear certified copies of their identity documents); certified copies of identity documents of directors / members / trustees / partnerships / individual; credit applications; latest audited financial statements; latest 3 (three) months’ bank statements; interim management statements; company letterhead; utility bill for all guarantors; trade references; 3 (three) months’ telephone account; resolution / power of attorney; confirmation of banking details (confirmation on bank letterhead); landlord waiver; insurance confirmation; settlement disclosures; ITC checks and reports (to request and to disclose information to third parties).

PURPOSE OF COLLECTION -MANDATORY
Processing of finance applications (internally and externally); drafting and finalising rental/instalment sale/transaction/facility agreements; to evaluate risk assessments in accordance with relevant and applicable legislation and regulations; comply with all tax and financial obligations; processing for invoice purposes; perform necessary background verification; communication; formalise client contractual arrangements which include upl oading, storage and maintaining information on our database.

INFORMATION TO INDEPENDENT FINANCE AGENT
The Credit Provider will subject all Credit Applications received, for verification by an independent third party, which include all approved finance houses for The Credit Provider and/or internal verification methods, of which the costs will be for The Credit Provider and/or the approved finance houses. The appointed third party will adhere to all necessary requirements in respect of POPI.950

Name and Surname*

Date*

Day

Month

Year

Signature*

Applicant Details

Contact Full Name*

Cell Number*

Contact Designation*

Contact Email Address*

Business Banking Details

Bank Name*

Account Number*

Branch Name*

Account Type*

Branch Number*

Overdraft Limit*

Company Contact Details & Address

Landline Number

Cell Phone Number*

Email Address*

Preferred Contact Method*

Company Registered Address (as per CIPC)*

Suburb*

City/Town*

Province*

Postal Code*

Head Office Address*

Suburb*

City/Town*

Province*

Postal Code*

Postal Address*

Property ownership*

Owned

Tenant

Is the property bonded?*

Yes

Current Value*

Outstanding Bond Amount*

Purchase Value*

Landlord Details*

Landlord Contact Details*

Directors / Members / Trustees / Partners

Full Name and Surname*

ID/Passport Number*

% Interest*

Please enter a number from 0 to 100.

CONSENT TO PROCESS PERSONAL INFORMATION IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT NO. 4 OF 2013 (POPI)

Name and Surname*

Date*

Day

Month

Year

Signature*

Details of Existing Fleet / Asset Register

Asset and Description

Financial Institution

Monthly Repayment

Outstanding balance

Remaining Period

Value of Asset

Use the “+” icon to add more rows

Personal Statement of Assets and Liabilities

Name*

Address*

Liabilities

With which bank is the bond held?

Liability

Net Value in Rand

Use the “+” icon to add more rows

Amounts owing on IS/Rental

Liability

Net Value in Rand

Use the “+” icon to add more rows

Loans received

Liability

Net Value in Rand

Use the “+” icon to add more rows

Details of Security Provided*

Total Liabilities*

Assets

Fixed Property Owned and Registered in Own Name

Asset

Net Value in Rand

Use the “+” icon to add more rows

Vehicles Owned (Market Value)

Asset

Net Value in Rand

Use the “+” icon to add more rows

Investments (Pvt Co Loans, Shares)

Asset

Net Value in Rand

Use the “+” icon to add more rows

Shares / Bills / Debenture held

Held

Company

Maturity Date

Use the “+” icon to add more rows

Personal Effects (Furniture / Jewelry)

Cash in bank

Savings

Other

Use the “+” icon to add more rows

Total Assets*

Assets less Liabilities*

Ownership Structure Declaration

Declaration passed by all the Directors/Members/Shareholders of

Registered name / Name of incorporation*

Registration / Incorporation number*

Wherin it was disclosed

That the Shareholding / Voting Rights / Membership Interest is correctly reflected in the below as stated ownership structure.

Shareholding / Voting Rights / Membership Interest

Name of Related Party

Related Party Type*

Identification / Passport Number or Registration Number

Shareholding / Voting Rights / Controlling Interest

Address and Contact Details

As per the above declaration, The Ultimate Beneficial Owner/s (UBO/s)** are as follows: Signed on 20 at Director/Shareholder

Name & Surname

Id Number / Passport

Address and Contact Details

SIGNED ON

Day

Month

Year

Signed at

Director / Shareholder / Authorised Signatory

* This can be i.e. a Shareholder/Voting Rights, Member of a CC, Trustees, Founder’s, Beneficiaries, Director’s, Partners.
**The UBO is the primary natural person or persons that “stand behind” that entity and its activities. They are a person/s who have the ultimate ownership and control over an entity.

Consent

Yes, I agree

Please tick this box to consent to receiving emails from Intello Group about exciting products, services, and opportunities. We promise not to spam you and will only send relevant updates.

Intello Group is the one-stop financial services solution that can finance almost any capital asset.

Facebook Linkedin-in

Explore

Home
Blog
About Us
Services
Contact Us

Support

Help Center
Career
FAQs
Privacy Policy
Contact

Contact Us

012 880 1416
072 3000 268

hello@intellogroup.co.za

Address

37 Sovereign Drive, Route 21 Business Park

08.00 AM - 16.00 PM

Terms & Services

Personal Details

Personal Bank Details

Home Ownership

Consent

Permissions

Applicant Details

Company Information

Business Banking Details

Company Contact Details & Address

Directors / Members / Trustees / Partners

Details of Existing Fleet / Asset Register

Personal Statement of Assets and Liabilities

Liabilities

Assets

Ownership Structure Declaration

Declaration passed by all the Directors/Members/Shareholders of

Wherin it was disclosed

Explore

Support

Contact Us

Address