Client Details:

Client type :
Title :Name :Surname :
Work Tel (no spaces):Cell Tel (no spaces):ID no (no spaces):
Email :
Physical address:
Postal address:
Marital Status :Gender :
Employer :

Finance Amount:

Amount Required: R Amount to be Ceded : R

Transaction Property:

Ownership Type :
Erf Number :Suburb :
Estate Agency:
Estate Agency Email:
Contact Person: Contact No (no spaces) :
Email: Estimated Registration Date:

Client's Banking Details:

Bank: A/c number: Branch code:
Account holder: Account type :

The Applicant Warrants:

a) that the above information is accurate and true and that no information that may affect GenFin's decision has been withheld;

Applicant is not the subject of debt counselling or under debt review and will not become over-indebted if

the Bridging Finance is granted; the Applicant is not currently black-listed;

b) that the Transaction Property does not form part of a new development, neither is it a proposed subdivision

and that transfer can be registered immediately;

c) if the Applicant is an Estate Agent, the Applicant warrants being in possession of a current Estate Agent's Board Fedility Fund

Certificate, a copy of which is attached to this Application.

The Applicant agrees that:

a) GenFin may make all necessary and reasonable enquiries into his/her credit worthiness in considering this application.

SIGNED AT Signature Date:


Client's Signature