Post on 28-Sep-2020
Version 1.6 (19/08/2019) Page 1 of 7
Home Loan Interview Form
New Loan Further Loan Qualified Buyer's Certificate
Section A:
Title GenderMale
Female
First Name/s
Surname
Current residential status Owner Tenant Other
Are you a first time home buyer? Yes No
ID Type
If passport, country of issue
Date of birth
Personal details
Refugee ID card number
(dd/mm/yyyy)
(dd/mm/yyyy)
Primary Applicant Co-applicant
GenderMale
Female
Owner Tenant Other
Yes No
Surety
Highest level of education
Do you currently smoke, or have you
smoked in the last 12 months any form
of tobacco or e-cigarettes?Yes No Yes No
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SA Citizen
Nationality
City of birth
Yes No Yes No
SA Permanent resident Yes No
Permit type
Are you a temporary resident of SA? Yes No
Permit numberPermit Expiry Date
(dd/mm/yyyy)
Yes No
Yes No
Permit Expiry Date(dd/mm/yyyy)
OtherWorkStudyPermanent
Country of birth
Marital status
If married ANC, register in both names
Married COP Married ANC
Divorced Other
Yes No
Single
Yes No
If married, country of marriage
No. of dependants No. of dependants
Ethnic GroupWe are required to request this in terms of the Home
Loan and Mortgages Disclosure Act, 2000.
SA Income tax number
Do you file any tax returns outside
of SA?Yes No Yes No
If tax number unavailable
If so, country and tax number
Will this property be your main
residence?Yes No Yes No
Asian Black Coloured White
OtherWorkStudyPermanent
Married COP Married ANC
Divorced Other
Single
Asian Black Coloured White
No tax number available No tax number issued No tax number available No tax number issued
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Contact Details
Home number
Cellphone number
Work number
E-mail address
Fax number
Residential Address
Street
Suburb
City
Country
Postal
code
Length at current address Years Months
Postal Address
Street / PO Box
Suburb
City
Country
Postal
code
Postal
code
Yes No
Suburb
City
Country
Postal
code
Primary Applicant Co-applicant / Surety
Contact and Address Details for Future Legal Correspondence (Only to be completed if different to postal address)
Years Months
Postal
code
Same as primary applicant
Postal
code
Home language
Language for correspondence
Street / PO Box
Legal notice delivery method Hand delivered Registered mail Hand delivered Registered mail
Section B:
Yes No
Same as residential address?
Name and surname of public
official in a position of authority that
you are related or associated with.
Yes No
What is the nature of the relationship or
association?
Yes No
Yes NoYes NoAre you a public official in a position of
authority?
Yes NoAre you related to or associated with a
public official in a position of authority?
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Section C: Employment Details
Occupation Status
Occupational Level
Full-time employed
Self-employed
Home Executive
Pensioner
Part-time employed
Temporary employed
Unemployed
Senior Management
Management
Supervisor
Skilled worker
Semi-skilled
Unskilled
Junior position
Primary Applicant Co-applicant / Surety
Occupation Status
Occupational level
Senior Management
Management
Supervisor
Skilled worker
Semi-skilled
Unskilled
Junior position
Full-time employed
Self-employed
Home Executive
Pensioner
Part-time employed
Temporary employed
Unemployed
Employment Details (Employed Only)
Nature of occupation
Employee number
Employment Period Years Months
Do you work in South Africa?
Street
Suburb
City
Postal code
Does this purchase coincide with a job change?
Were you previously employed?
Yes No
Yes No
Yes No
Country
Company registration no
Nature of occupation
Employee number
Employment Period Years Months
Do you work in South Africa?
Street
Suburb
City
Postal code
Does this purchase coincide with a job change?
Were you previously employed?
Yes No
Yes No
Yes No
Country
Company registration no
Percentage of income derived from own business (if any)
Are you a shareholder of your employer’s business?
Percentage shareholding (if yes)
Yes No
Percentage of income derived from own business (if any)
Are you a shareholder of your employer’s business?
Percentage shareholding (if yes)
Yes No
Previous Employment Details (Two Most Recent)
Previous employer
Duration Years
Previous employer
Duration Years Months
Months
Co-applicant / Surety
Years
Years Months
Months
Primary Applicant
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Are you currently under any debt re-arrangement?
Have you ever been declared insolvent?
Date of insolvency (dd/mm/yyyy)
If rehabilitated, date (dd/mm/yyyy)
Are you currently in a credit bureau dispute?
Yes No
Yes No
Yes No
Existing Suretyships
Are you bound by any surety agreements?
Will you be settling this account/debt?
If yes, specify amount*
Are you currently paying this account?
New Instalment (only capture if
Instalment / payment will be reduced)
Monthly Instalment
Surety in favour of
Details of suretyship
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
* If bound by multiple surety agreements then
combine the values.
Yes No
Yes No
Yes No
Are you aware of any adverse credit listings? Yes No Yes No
If yes, specify
Primary Applicant Co-applicant / Surety
Loan Details
Monthly instalment type
Preferred debit order date
Erf number / Section number
Street / Complex
Suburb
Amount to be registered
R
R
Debit Order Direct from salary
Section E:
Section D: Credit History
Are you currently under Administration?
Has a judgement ever been taken against you?
Yes No
Yes No
Primary Applicant Co-applicant / Surety
Yes No
Yes No
Were you ever under Administration? Yes No Yes No
Are you currently under debt review? Yes No Yes No
Debt counsellor name
Debt counsellor phone
number
Version 1.6 (19/08/2019) Page 5 of 7
Total income R
ROther income description
R
R
Section F: Monthly Income, Deductions and Expenses
Monthly Income
Gross salary R
Primary Applicant Co-applicant / Surety
R
Average commission R R
Investment income R R
Rental income R R
Car allowance R R
Travel allowance R R
ROther income description R
Monthly Deductions
Tax (PAYE/SITE)
Pension
Total deductions
UIF
Medical Aid
R
R
R
R
R
Other deductions description
Other deductions description
R
R
RIncome after
deductions
R
R
R
R
R
R
R
R
RR
R
R R
R
R
RR
R
Entertainment allowance
Income from aureties
Housing subsidy
Maintenance/ alimony
Average overtime
(past 6 months)
Primary Applicant Co-applicant / Surety
Primary Applicant Co-applicant / Surety
Total income
Primary Applicant Co-applicant / Surety Primary Applicant Co-applicant / Surety
Primary Applicant Co-applicant / Surety
Monthly Expenses
Rental (only if ongoing)
Maintenance / Alimony
Rates and taxes / Levies
Water and electricity
Assurance (life, retirement
annuities, insurance and
funeral policies)
Groceries
Transport, petrol and car
maintenance
Security
R
R
R
R
R
R
R
R
Education
Medical (excl. medical aid
salary deductions)
Cellphone / internet (if not
on contract)
M-Net, DSTV and TV
R
R
R
R
R
R
Other expenses
description
Primary Applicant Co-applicant / Surety
R
R
R
R
R
R
R
R
R
R
R
R
R
ROther expenses
description
Monthly Expenses
Total
expenses
Net surplus
income / deficit
Signed
Primary applicant
Date
(dd/mm/yyyy)
Total
expenses
Net surplus
income / deficit
Signed
Co-applicant /
Surety
Date (dd/mm/yyyy)
Co-applicant / SuretyPrimary Applicant
Other expenses
Other expenses
Primary Applicant Co-applicant / Surety
Version 1.6 (19/08/2019) Page 6 of 7
Section G:
Account type (only cheque or savings)
Bank / Financial Institution
Account holder name
Account number
Is this account in the name of the Legal Entity?
Business bank account?
Balance Debit (-) Credit (+)
Yes No
Yes No
Yes No
Yes No
Account type (only cheque or savings)
Bank / Financial Institution
Account holder name
Account number
Is this account in the name of the Legal Entity?
business bank account?
Balance Debit (-) Credit (+)
Yes No Yes No
For FNB, RMB and Standard Bank Primary Banked Customers Only: Your Bank has requested the opportunity to consider your home loan application first for
a period of time. I consent to this arrangement:
Branch Branch
Primary Transactional Bank Account Details And Contractual Expenses
Other Bank / Finance Account Details (eg. credit cards, vehicle finance, personal loans) - Primary Applicant
Bank / Financial Institution Account type Monthly Payment
Yes No Yes No Yes No
Current Balance Will this account
be settled?
Is this a Business
account?
Is this a Legal
Entity account?
Co-applicant / Surety
Bank / Financial Institution Account type Monthly Payment
Yes No Yes No Yes No
Current Balance Is this a Business
account?
Is this a Legal
Entity account?
Retail Accounts
Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Name of Retail Store Current
Balance
Monthly
Payment
Name of Retail Store Current
Balance
Monthly
Payment
Will this account
be settled?
Home Loans
Bank / Financial Institution
Account holder name
Monthly installment/ Minimum
payment
Outstanding balance
Branch
Are you selling the existing property?
New installment (if reduced)
Yes NoYes No Yes NoYes No
Will this account
be settled?
Will this account
be settled?
Account 1 Account 1Account 2 Account 2
Primary Applicant Co-applicant / Surety
Primary Applicant Co-applicant / Surety
Primary Applicant Co-applicant / Surety
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Section H: Assets & Liabilities
Market Value Liabilities Market Value Liabilities
Fixed property
Vehicles
Investments
R
R
R
R
R
R
R
R
Furniture & fittings
R
R
R
R
R
R
R
R
Primary Applicant Co-applicant / Surety
Other assets / liabilities
R R
Total Assets / Liabilities
Total Assets
Total Liabilities
R R
Net Asset Value
R
Description Market Value Liabilities
R R
Description Market Value LiabilitiesOther assets / liabilities
R R
Total Assets / Liabilities
Total Assets
Total Liabilities
R R R
R R
R R R R
R R R R
Section I:
I/We, the undersigned,
a) Consent to ooba making application for home loan finance on my/our behalf.
b) Acknowledge that personal, financial and other information is furnished to ooba for the purposes of making application for
home loan finance and are aware that I/we are required to furnish all such information truthfully and fully.
c) Consent to ooba receiving all communication from the bank/s (including the quotation) pertaining to my/our home loan
application. I/We consent to ooba issuing the estate agent with a copy of the quotation.
d) Consent to ooba & third parties, including banks, making enquiries to credit bureaux when assessing my/our home loan
application for finance.
e) Hold no other citizenships and residence for local and international tax purposes, other than those disclosed in this application
form and will inform the lender in writing of any change of this status within 30 days of the change of status.
f) Consent to Standard Bank, ABSA and Nedbank electronically retrieving my/our bank statements.
Declarations and Consents
g) Do hereby appoint (“our Representative at ooba”)
to be my/our lawful representative and agent in my/ our name, place and stead and to obtain a copy of my/our personal credit
reports (“PCR”) from Experian South Africa (Pty) Ltd. The PCR is to be used solely for the purpose of providing me/us with
advice or assistance with managing my/our credit, by having reference to the content of my/our PCR. I/We consent to
Experian releasing a copy of my/our PCR to my/our Representative and to my/ our Representative having sight of the content
of my/our PCR for the above purpose.
Signed
Primary applicant
Date (dd/mm/yyyy)
Signed
Co-applicant / Surety
Date (dd/mm/yyyy)
Net Asset Value