1. MR NAIDOO.SALID
MOBILE No: 081 241 4410
FAX No: 086 546 2751
TEL No: 011 053 7918
EMAIL:macroloan@financier.com
No.117 JP STATION STREET
JOHANNESBURG
SOUTH AFRICA
Application Form
Please complete and return by fax or email. 2003/021297/23
ADVICE NOTES
SOUTH AFRICAN
ID/PASSPORT NUMBER
Have you been blacklisted? YES NO
Loan Amount: Loan Duration:
Account coordinates
(Details of the account
Where you want your
Loan funds
Transferred.
How would you want your money to be transferred to
you? Bank transfer
Bank name: …………………………………. Account Nº: ………………… ……………….
Bank Address: …………………………… …………. City: ……………………
State: …………………………......................Post Code..
Full Name:
Address:
City:
Telephone. Nº:
Email:
State:
Mobile:
Date of Birth: Nationality:
Post Code:
Fax Nº:
Occupation:
Please give the
Applicant’s full
Postal address.
Other Information of you
Company Name:
Company
Telephone:
Company
Address
City State
Period of year
In that
Company fax:
Post Code
Declaration
I (MR/MRS/MISS) ……………………………................................................................. HEREBY DECLARE THAT THE
ABOVE DATA / INFORMATION GIVEN ARE TRUE TO THE BEST OF YOUR KNOWLEDGE AND INCASE
OF FALSIFICATION, THE LOAN SHOULD NOT BE APPROVED FOR ME.
DATE: …………………………… SIGNATURE: ………………………………….
CAMELO -FINANCE -SOLUTION -PTY