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About Us
Our Story
Our Team
Anuva Green Energy
Anuva Green Energy
Anuva Impact Fund
Investments
Equity
Fixed Income
Property
Private Funds
Section 12J
Knowledge
Information Video Series
FAQ’s
Annual Financials
APE Prospectus
News
Highrise Magazine
Contact
Complaint
Enquire
APPLY FOR A
CONVERTIBLE INVESTMENT LOAN
I am applying as an
*
an Individual
a Company
a Trust
Personal Details
Title
*
Surname
*
First Names
*
South African ID Number
*
Income Tax Number
*
Marital Status
*
Married
Single
Divorced
Married how
*
ANC
COP
Other
Please specify
*
Number of dependants
*
Current residential status
*
Owner
Tenant
Other
Please specify
*
Address & Contact Details
Telkom number
Cellphone Number
*
E-mail
*
Residential Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Postal Address (if different to above)
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Loan Details
Loan amount being applied for [R]
*
Monthly instalment payment method
*
Debit Order
Credit History
Have you ever been declared insolvent?
*
Yes
No
Date
*
If so, have you been rehabilitated?
*
Yes
No
Date
*
Have you ever been under administration?
*
Yes
No
Date
*
Applied for, or under debt review?
*
Yes
No
Date
*
Any debt re-arrangements in place?
*
Yes
No
Have you ever had a judgement?
*
Yes
No
Are you aware of any adverse credit listings?
*
Yes
No
Are you currently in a Credit Bureau dispute?
*
Yes
No
Have you signed any surety?
*
Yes
No
Value of any suretyship agreements [R]
*
Employment Details
Name of Business/Employer
*
Nature of Business
*
Position
*
Employment Status
*
Tel Number
*
Physical Address of Business/Employer
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Length of current employment
Years
*
Months
*
Do you work in South Africa?
*
Yes
No
If employed for less than 3 yrs., state previous employer, period employed and contact number
Tel Number
Years
Main Transactional Bank Account
Transactional Bank Account Type
*
Transactional Bank Account Number
*
Bank Name
*
Branch Name
*
Branch Code
*
Is this a business account?
*
Yes
No
Is this a legal entity account?
*
Yes
No
Name of account holder
*
Monthly / Minimum payment of overdraft if applicable [R]
Home Loan Accounts
Home Loan 1
Name of bank / homeloan provider
Account Number
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Home Loan 2
Name of bank / homeloan provider
Account Number
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Home Loan 3
Name of bank / homeloan provider
Account Number
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Other Monthly Commitments (Eg. Retirement Contributions/Savings, Credit Cards, Vehicle Finance, Retail Accounts, Personal Loans)
Monthly Commitment 1
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Monthly Commitment 2
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Monthly Commitment 3
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Monthly Commitment 4
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Income Details /Month
Salary [R]
Commission [R]
Allowances [R]
Other
Amount [R]
Other
Amount [R]
Other
Amount [R]
Deductions
PAYE [R]
UIF [R]
Pension [R]
Medical Aid [R]
Other
Amount [R]
Total Income [R]
Expenditure
Home loan instalments [R]
Hire Purchase and Vehicle Finance [R]
Credit card repayments [R]
Retail instalments [R]
Home Rental (only applicable if ongoing) [R]
Investments (unit trusts / endowments) [R]
Rates & Taxes/Levies [R]
Water & Lights [R]
House maintenance & garden services [R]
Petrol, travel cost & maintenance [R]
Insurance (House, Vehicle, Life, RA's) [R]
Cell phone & Telephone [R]
Groceries [R]
Domestic Wages [R]
Education [R]
All other expenses (Clothing, Entertainment, TV Subscriptions etc.) [R]
Other [R]
Total Expenses [R]
Net Income [R]
Assets & Liabilities
Property/ies
Property 1
Address
Market value
Liability
Property 2
Address
Market value
Liability
Property 3
Address
Market value
Liability
Property 4
Address
Market value
Liability
Vehicle/s
Vehicle 1
Make/model and year
Market value
Liability
Vehicle 2
Make/model and year
Market value
Liability
Vehicle 3
Make/model and year
Market value
Liability
Bank (cash/deposits and overdrafts)
Bank 1
Specify
Market value
Liability
Bank 2
Specify
Market value
Liability
Bank 3
Specify
Market value
Liability
Investments and type (unit trusts /shares)
Investment 1
Specify
Market value
Liability
Investment 2
Specify
Market value
Liability
Investment 3
Specify
Market value
Liability
Household Contents
Content 1
Specify
Market value
Liability
Content 2
Specify
Market value
Liability
Content 3
Specify
Market value
Liability
Jewellery
Jewellery 1
Specify
Market value
Liability
Jewellery 2
Specify
Market value
Liability
Jewellery 3
Specify
Market value
Liability
Other
Other 1
Specify
Market value
Liability
Other 2
Specify
Market value
Liability
Other 3
Specify
Market value
Liability
Total
Market value
Liability
Notifications
Applicant/s are aware that:
a)Â The applicant has requested Flyt 12J to proceed with such application for an Anuva Convertible Investment Loan;
b)Â The information furnished by the applicant/s to Flyt 12J in this application is for the purposes of the making of such application for a personal loan, and applicants are aware that they are required to furnish all such information truthfully and fully;
c) Flyt 12J and third parties, including Flyt 12J's partners, may make enquiries to third parties to confirm any information submitted as part of the application, and may obtain information from credit bureaux and SARS when assessing this application for finance.
d)Â Communications (including the quotation) from Flyt 12J or any other bank(s) pertaining to such application will be received by Flyt Property Investment on the applicants behalf. Where appropriate, Anuva Investments may be furnished with a copy of the final outcome; and by signing this document, the applicants acknowledge and agree to this.
e) For local and international tax purposes, I/we hold no other citizenships or residencies other than those disclosed in this application form. Should there be any change in this status, I/we shall inform the lender with 30 days thereof.
Signatures
I/we confirm that the notifications above have been read & understood.
*
Yes
No
Company Details
Company Name
*
Registration Number
*
Income Tax Number
*
Full name of Person to act on behalf of the Company
*
Contact Number of Person to act on behalf of the Company
*
Email Address of Person to act on behalf of the Company
*
Registered Address of the Company
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Loan Details
Loan amount being applied for [R]
*
*A loan consultant will get in touch with requirements for a business application
Trust Details
Name of Trust
*
Trust Deed Number
*
Income Tax Number
*
Full name of Person to act on behalf of the Trust
*
Contact Number of Person to act on behalf of the Trust
*
Email Address of Person to act on behalf of the Trust
*
Registered Address of the Trust
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Loan Details
Loan amount being applied for [R]
*
*A loan consultant will get in touch with requirements for a trust application
Verification
Please enter any two digits
Example: 12
This box is for spam protection -
please leave it blank
I am applying as an
*
an Individual
a Company
a Trust
Personal Details
Title
*
Surname
*
First Names
*
South African ID Number
*
Income Tax Number
*
Marital Status
*
Married
Single
Divorced
Married how
*
ANC
COP
Other
Please specify
*
Number of dependants
*
Current residential status
*
Owner
Tenant
Other
Please specify
*
Address & Contact Details
Telkom number
Cellphone Number
*
E-mail
*
Residential Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Postal Address (if different to above)
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Loan Details
Loan amount being applied for [R]
*
Monthly instalment payment method
*
Debit Order
Credit History
Have you ever been declared insolvent?
*
Yes
No
Date
*
If so, have you been rehabilitated?
*
Yes
No
Date
*
Have you ever been under administration?
*
Yes
No
Date
*
Applied for, or under debt review?
*
Yes
No
Date
*
Any debt re-arrangements in place?
*
Yes
No
Have you ever had a judgement?
*
Yes
No
Are you aware of any adverse credit listings?
*
Yes
No
Are you currently in a Credit Bureau dispute?
*
Yes
No
Have you signed any surety?
*
Yes
No
Value of any suretyship agreements [R]
*
Employment Details
Name of Business/Employer
*
Nature of Business
*
Position
*
Employment Status
*
Tel Number
*
Physical Address of Business/Employer
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Length of current employment
Years
*
Months
*
Do you work in South Africa?
*
Yes
No
If employed for less than 3 yrs., state previous employer, period employed and contact number
Tel Number
Years
Main Transactional Bank Account
Transactional Bank Account Type
*
Transactional Bank Account Number
*
Bank Name
*
Branch Name
*
Branch Code
*
Is this a business account?
*
Yes
No
Is this a legal entity account?
*
Yes
No
Name of account holder
*
Monthly / Minimum payment of overdraft if applicable [R]
Home Loan Accounts
Home Loan 1
Name of bank / homeloan provider
Account Number
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Home Loan 2
Name of bank / homeloan provider
Account Number
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Home Loan 3
Name of bank / homeloan provider
Account Number
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Other Monthly Commitments (Eg. Retirement Contributions/Savings, Credit Cards, Vehicle Finance, Retail Accounts, Personal Loans)
Monthly Commitment 1
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Monthly Commitment 2
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Monthly Commitment 3
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Monthly Commitment 4
Name & account or credit card type
Current balance
Monthly payment/repayment [R]
Will this account be settled by the new loan?
Yes
No
Income Details /Month
Salary [R]
Commission [R]
Allowances [R]
Other
Amount [R]
Other
Amount [R]
Other
Amount [R]
Deductions
PAYE [R]
UIF [R]
Pension [R]
Medical Aid [R]
Other
Amount [R]
Total Income [R]
Expenditure
Home loan instalments [R]
Hire Purchase and Vehicle Finance [R]
Credit card repayments [R]
Retail instalments [R]
Home Rental (only applicable if ongoing) [R]
Investments (unit trusts / endowments) [R]
Rates & Taxes/Levies [R]
Water & Lights [R]
House maintenance & garden services [R]
Petrol, travel cost & maintenance [R]
Insurance (House, Vehicle, Life, RA's) [R]
Cell phone & Telephone [R]
Groceries [R]
Domestic Wages [R]
Education [R]
All other expenses (Clothing, Entertainment, TV Subscriptions etc.) [R]
Other [R]
Total Expenses [R]
Net Income [R]
Assets & Liabilities
Property/ies
Property 1
Address
Market value
Liability
Property 2
Address
Market value
Liability
Property 3
Address
Market value
Liability
Property 4
Address
Market value
Liability
Vehicle/s
Vehicle 1
Make/model and year
Market value
Liability
Vehicle 2
Make/model and year
Market value
Liability
Vehicle 3
Make/model and year
Market value
Liability
Bank (cash/deposits and overdrafts)
Bank 1
Specify
Market value
Liability
Bank 2
Specify
Market value
Liability
Bank 3
Specify
Market value
Liability
Investments and type (unit trusts /shares)
Investment 1
Specify
Market value
Liability
Investment 2
Specify
Market value
Liability
Investment 3
Specify
Market value
Liability
Household Contents
Content 1
Specify
Market value
Liability
Content 2
Specify
Market value
Liability
Content 3
Specify
Market value
Liability
Jewellery
Jewellery 1
Specify
Market value
Liability
Jewellery 2
Specify
Market value
Liability
Jewellery 3
Specify
Market value
Liability
Other
Other 1
Specify
Market value
Liability
Other 2
Specify
Market value
Liability
Other 3
Specify
Market value
Liability
Total
Market value
Liability
Notifications
Applicant/s are aware that:
a)Â The applicant has requested Flyt 12J to proceed with such application for an Anuva Convertible Investment Loan;
b)Â The information furnished by the applicant/s to Flyt 12J in this application is for the purposes of the making of such application for a personal loan, and applicants are aware that they are required to furnish all such information truthfully and fully;
c) Flyt 12J and third parties, including Flyt 12J's partners, may make enquiries to third parties to confirm any information submitted as part of the application, and may obtain information from credit bureaux and SARS when assessing this application for finance.
d)Â Communications (including the quotation) from Flyt 12J or any other bank(s) pertaining to such application will be received by Flyt Property Investment on the applicants behalf. Where appropriate, Anuva Investments may be furnished with a copy of the final outcome; and by signing this document, the applicants acknowledge and agree to this.
e) For local and international tax purposes, I/we hold no other citizenships or residencies other than those disclosed in this application form. Should there be any change in this status, I/we shall inform the lender with 30 days thereof.
Signatures
I/we confirm that the notifications above have been read & understood.
*
Yes
No
Company Details
Company Name
*
Registration Number
*
Income Tax Number
*
Full name of Person to act on behalf of the Company
*
Contact Number of Person to act on behalf of the Company
*
Email Address of Person to act on behalf of the Company
*
Registered Address of the Company
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Loan Details
Loan amount being applied for [R]
*
*A loan consultant will get in touch with requirements for a business application
Trust Details
Name of Trust
*
Trust Deed Number
*
Income Tax Number
*
Full name of Person to act on behalf of the Trust
*
Contact Number of Person to act on behalf of the Trust
*
Email Address of Person to act on behalf of the Trust
*
Registered Address of the Trust
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Loan Details
Loan amount being applied for [R]
*
*A loan consultant will get in touch with requirements for a trust application
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