Loan Application Need A Trusted Professional Medical Loan? Enter your details and apply now Name Surname ID Number Your Personal Email Your Current Work Email Cell Phone Number City Physical Address Province Gauteng Western Cape Eastern Cape Northern Cape Limpopo KwaZulu-Natal North West Mpumalanga Free State What Best Describes Your Property Ownership? - Owned Rented Family Owned Company Dwelling How Many Years Have You Lived There? - Less Than 1 Year 1 - 3 Years 3 - 5 Years 5 + Years What Is Your Marital Status? - Married ANC Married COP or Customary Law Divorced Single Widowed If you are married in community of property or by customary Law, it is a legal requirement in terms of the matrimonial property act, to obtain consent from your spouse to enter into any credit agreement. If so, please confirm you have received this consent. I Have Received Consent Where Did You Hear About Enhancive? Next Of Kin Full Name Relationship Contact Number Email Address How Much Will Your Procedure Cost? Select Your Payment Method 6 Months 12 Months 24 Months Name Of The Procedure You Are Interested In Getting A Loan For Name Of Clinic 1 Clinic Name Clinic Email Address Clinic Contact Number Clinic Contact Person Who Will Be Doing The Procedure? Voucher Code Name Of Employer Telephone Number Of Employer Employment Status Permanent / Full Time Part-time / Casual Contract Work Self Employed Housewife Retired Student Medically Boarded Disability Unemployed How Long Have You Been Employed? - Less Than 1 Year 1 - 3 Years 3 - 5 Years 5 + Years Nett Monthly Salary - After All Deductions Best Day Of The Month For A Debit Order - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Are You Under Debt Review Or Sequestration Or Do You Plan To Apply For Debt Review? Yes No Last 3 Months Payslips (Don't have them on you right now? No sweat, you can email it to us later) Payslip 1 (File uploads may not work on some mobile devices) Payslip 2 (File uploads may not work on some mobile devices) Payslip 3 (File uploads may not work on some mobile devices) Last 3 Months Bank Statements (Don't have them on you right now? No sweat, you can email it to us later) Bank Statement 1 (File uploads may not work on some mobile devices) Bank Statement 2 (File uploads may not work on some mobile devices) Bank Statement 3 (File uploads may not work on some mobile devices) Get Updates Yes, I would like to receive updates and marketing communication which may include a monthly newsletter. Credit Check Consent I Consent To A Credit Check I hereby consent and authorise that Inkfin (Pty) Ltd contact, request and obtain information from a registered credit bureau, to perform an assessment of my behaviour, profile, payment patterns, indebtedness and creditworthiness, and make any reasonable enquiries to verify and research any details provided by me to Inkfin (Pty) Ltd. By Submitting This Form, You Accept Our Terms & Conditions & Privacy Policy Send
