2013 Mercedes-Benz E-Class E250CGI Coupe Elegance – Mit-Mak Motors

Vehicle Description*

Name*
First Last
Phone*
Email*

Sales Executive's Name

Have not been assisted by a sales executive yet
Can’t remember the sales executives name
Proof Of Payment*
Max. file size: 10 MB.
Buyer Signature*
Digital Signature

Step 1 of 12

FINANCE APPLICATION (Single Applicant)
Please use Full Name and Surname as on your Identification Card/Book
Name*
First Last
Identity Number*
Identity Number (Please Make Sure You have entered your ID NO. correctly ,Else The Form Will Not Be Submitted Automatically)

Address
Address

Street Address Address Line 2 State / Province / Region ZIP / Postal Code Country

Number of years residing at the above address
Number of years residing at the above address

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PERSONAL INFORMATION (Single Applicant)
Email*
Email

Mobile / Cell Phone*
Mobile / Cell Phone
Phone*
Telephone Home
Phone*
Telephone Work
Graduate (Completed an academic degree or course of training)

Graduate
Yes
No
Relationship Status
Relationship Status
Relationship Status
Only if applicable
Married In or Out Community of Property
Date
Date You Got Married
Spouse Details, If Married In Community of Property (Else You Can Skip)
Spouse Details
First Last
Spouse Identity Number
Identity Number (Please Make Sure You have entered your spouse's ID NO. correctly.)

Spouses Mobile / Cell Phone
Spouses (Mobile / Cell Phone)

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NEXT OF KIN (Not residing with you)
Next of Kin
Next of Kin
First Last
Next Of Kin Relationship
Next Of Kin Relationship
Next of Kin Contact Number
Next of Kin Contact Number
Next of Kin Address
Next of Kin Address

Street Address Address Line 2 State / Province / Region ZIP / Postal Code Country

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CURRENT EMPLOYER DETAILS (Single Applicant)
Current Employer
Current Employer

Occupation
Occupation
Employer Contact Number
Employer Contact Number
Nr of Years at Company
Nr of Years at Company
Salary day
Salary Day
Employer Address
Employer Address

Street Address Address Line 2 State / Province / Region ZIP / Postal Code Country

PREVIOUS EMPLOYER DETAILS (Single Applicant)
Previous Employer
Previous Employer

Nr of Years at Previous Company
Nr of Years at Previous Company
S189 Retrenchment*
In the last 6 months, have you received an S189 Retrenchment Notification from your employer?

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SALARY DETAILS (Single Applicant)
Monthly Gross Salary*
Monthly Gross Salary Before Deductions
Commission
Commission (If any)
Car Allowance
Car Allowance (If any)
Monthly Nett Income
Monthly Nett Take Home Pay
OTHER INCOME (Single Applicant)
Source of Other Income
Source of Other Income

Other Income Amount
Other Income Amount

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BOND DETAILS (Single Applicant)
Bond Holder
Bond Holder

Amount Outstanding
Amount Outstanding
Property Value
Property Value
Monthly Instalment
Monthly Instalment
Purchase Price
Purchase Price
Purchase Date
Purchase Date

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MONTHLY EXPENSES (Single Applicant)
Bond Payment / Rent*
Bond Payment / Rent
Vehicle installments
Vehicle installments (Excluding Those To Be Settled)
Credit Card Repayments
Credit Card Repayments Amount
Clothing Accounts
Clothing Accounts
Policy / Insurance Repayments
Policy / Insurance Repayments
Transportation Costs
Transportation Costs
Education Costs
Education Costs
Household Expenses*
Household Expenses
Please enter a number greater than or equal to 1.
Rates, Water and Electricity
Rates, Water and Electricity
Personal Loan Repayments
Personal Loan Repayments
Furniture Accounts
Furniture Accounts
Overdraft Repayments
Overdraft Repayments
Telephone Payment
Telephone Payment
Food and Entertainment
Food and Entertainment
Maintenance
Maintenance
Other
Other

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BANKING DETAILS (Single Applicant)
Name of Account Holder
Name of Account Holder

Bank Name
Bank Name
Branch Name
Branch Name

Branch Code
Branch Code

Account Number
Account Number

Account Type
Account Type

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Can Skip If Documents Aren't Available
South African ID
South African ID
Max. file size: 10 MB.
Drivers Licence
Drivers Licence
Max. file size: 10 MB.
3 Months Bank Statements
3 Months Bank Statements

Drop files here or

Max. file size: 16 MB.

3 Months Payslips
3 Months Payslips

Drop files here or

Max. file size: 16 MB.

Proof of Residence
Proof of Residence
Max. file size: 16 MB.

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What Vehicle Are You Interested In To Apply For Finance
Vehicle Are You Interested In
Enter Vehicle Make (e.g. Ford )

Vehicle Model
Enter Vehicle Model (e.g. Everest )

Vehicle Year
Enter The Vehicle Year (i.e. 2016)

Sales Executives Details
Sales Executive's Name
Sales Executive's Name

Sales Executives
Have not been assisted by a Sales Executive Yet.
Can't Remember Sales Executives Name.
Do You Have A Trade-In (Can skip if you don't have)
Vehicle Make
Enter Vehicle Make Ex(Ford)

Vehicle Model
Enter Vehicle Model Ex(Everest 2.2 XLT)

Vehicle Manufacturer Year
Enter Vehicle Manufacturer Year Ex(2018)

Current Mileage of Vehicle
Enter Current Mileage of Vehicle Ex(23 000km)

Vehicle's Photos
Upload Your Vehicle's Photos
Max. file size: 16 MB.

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You're Almost There, Just a Few Questions Left 😀.

Hidden
IDV GUID

Question 1
Is one of the following accounts in your name?
Question 2
Is one of the following accounts in your name?
Question 3
Please select your employer from this list
Question 4
Do you own property?
Question 5
Are you a director of a company ?
Hidden
passcheck

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Consent*
By checking the box I confirm that I have read and understand the declaration by applicants and agree to send all my Personal information to Mit-Mak Motors, to determine my credit score and for the purpose of performing an affordability and pre-qualification finance assessment to obtain my consumer credit information, finance application and financial information, from all credit bureaus and relevant third parties to make the aforementioned information available to me as well as share my personal info with third parties only related to the finance and purchase of a vehicle, I also agree that I understand the T's and C's of this website.

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