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REYRAMS FINANCIAL SERVICES (NCRCP17676)

LOAN APPLICATION FORM

Check Request Form (#5)

BUSINESS LOAN

If you are in need of funds, please fill out the following check request. We will reach out to you once the request has been approved. If this is an emergency, please contact the financial department directly.

COMPANY DETAILS

Entity Name

Trading as:

Company type:

Company registration number:

Tel:

Date of registration

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Annual turnover- Year 1

Annual turnover- Year 2

Annual turnover- Year 3

Industry Classification

Amount Requested (in Rands)

Director details/ Authorized Signatory :

First Name

Last Name

Company URL:

Identity Card Number

Contact Number:

Residential address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Documents to be attached with application: Please email to: business@reyrams.com

Incorporation documents

Latest Audited Financials

Director's copy of ID

Third party quotation/ Invoice

DECLARATION AND CONSENT

I/We authorise Reyrams (Pty) Ltd/its Group Companies/its Agents to make reference and credit enquiries relevant to information in this Application Form which Reyrams (Pty) Ltd/its Group Companies/its Agents consider necessary. I/We undertake to inform Reyrams (Pty) Ltd/its Group Companies/its Agents regarding the change in the residential addresses/employment/profession and to provide any further information that Reyrams (Pty) Ltd/its Group Companies/its Agents may require. I/ We further declare and confirm that the credit facilities if any enjoyed by me/us with banks/financial institutions/non banking finance companies has been disclosed here in above. I/We agree that Reyrams (Pty) Ltd may provide the credit facilities mentioned herein only if permitted and if approved in the manner specified or required by the Relevant government structures from time to time. I/We confirm that I/We shall not use the credit facility (or any part thereof) for any improper, illegal or unlawful purpose/activities. I/We have been read out and explained in the language known to me/us, the contents of the Application Form for availing the loan from Reyrams (Pty) Ltd by the executive of the Bank and I/we have signed the said Application Form after having understood them and by signing the same. I/we wish to avail of the COLLECTION FACILITY/Direct Debit facility and hereby express my/our unconditional consent to debit my/our loan instalments etc., from above mentioned account through COLLECTION FACILITY/ Direct Debit. l/We authorize the bank to honour all such instructions. l/ we authorize the representative of the Company to get this mandate verified and registered with bank. Mandate Verification Charges (if any) may be charged to my/our account. I/We will ensure sufficient balance in the funding account on the date of execution. In case COLLECTION FACILITY/Direct Debit instruction is unsuccessful due to financial reasons, the COLLECTION FACILITY/Direct Debit instructions will be presented again for clearance. I/We will bear the bounce changes for transactions that have been unsuccessful due to financial reason.

You consent to ReyRams Finance conducting a credit enquiry about you(Director) and confirming your details with any credit bureau, credit provider or third party and share your personal information including your loan application, this agreement, termination thereof and non-compliance with these terms and conditions to: credit risk management services (including credit bureaus approved by the NCR to host consumer payment profile information and possibly provide consumer credit scores on creditworthiness); and/or crime prevention agencies. The contact detail of the various credit bureaus can be obtained from our Customer Service Centre. You have the right to contact the credit bureaus and look at your record with them and correct any information that is wrong.