Vutomi Bilankulu Name* First Names Surname Date* Date Format: MM slash DD slash YYYY Identity Number:*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Marital status: Married Single Divorced Widowed Separated Other If married or separated: I am married with ante nuptial contract (out of community of property) I am married in community of property and have the written consent of my spouse to enter this loan agreement if approved. PhoneEmail Employment Status: Working full time Working part time Self-employed Retired Student Other Employers Name and Province:*Position held:*Number of years at current employer:*Monthly Salary:*Loan amount:*(R500 – R5 000) Term of loan in months:*(1 – 6 months)*Purpose of loan:Statement of monthly personal income and expensesGross salary before payslip deductions:*Total monthly payslip deductions:*Net income after payslip deductions:*Other income (Specify):Total income after deductions:ExpensesMonthly term lending repayments: (Home loans, vehicle finance, personal loans)Monthly card repayments: (Credit cards, store cards, furniture retailers)Communication expenses: (Cell phone and data)Household and family expenses: (Education, utilities, groceries, levies, rental, maintenance, garden, domestic, securityInsurance and retirement: (Insurance and retirement typically not included in your monthly salary deductions)Transport: (Fuel, public transport)Other: (Entertainment, restaurants, bank fees, etc.)Total monthly income after expensesI confirm that:* I confirm that the above information is correct and give consent to SADTU SACCO to verify the information where required. I am not under administration or curatorship, insolvent, undergoing debt counselling, or have any pending disputes with a credit bureau. I give consent to SADTU SACCO to perform a credit check on me. Supporting documents attached: ID copy Proof of address Latest payslip 3 months bank statements Attach the above supporting documents attached: Drop files here or Accepted file types: (jpg, gif, png, pdf). Member’s signature:*Date* Date Format: MM slash DD slash YYYY