CORPORATE APPLICATION FORM BUSINESS INFORMATIONRequired fields marked with *Name of Business *Trading NameRegistration Number *Email *Business PhoneBusiness Mobile *Business Physical Address *Business AddressBusiness Postal AddressBusiness Postal AddressUpload Proof of Physical AddressChoose FileNo file chosenDelete uploaded fileLanguagePlease selectEnglishAfrikaansSelect LanguageDo you own fixed property? *Please selectYesNoIf not, do you:RentOtherWere you previously a member of Pretorium Trust?YesNoIf 'Yes' Membership NumberINFORMATION OF BUSINESS OWNERRequired fields marked with *Surname *Intials *Business PhoneMobile *Street Address *Suburb *City *Province *Postal Code *INFORMATION OF BUSINESS ASSOCIATERequired fields marked with *SurnameIntialsBusiness PhoneMobileStreet AddressSuburbCityProvincePostal CodeAUTHORISED CARD HOLDERSRequired fields marked with *Title and Initials *Surname *ID Number *Please insert a valid 13-digit South African ID number0 / 13Card LimitZARSignature *Start signing your signature hereYour browser does not support e-Signature field.Title and InitialsSurnameID Number0 / 13Card LimitZARSignatureStart signing your signature hereYour browser does not support e-Signature field.Title and InitialsSurnameID Number0 / 13Card LimitZARSignatureStart signing your signature hereYour browser does not support e-Signature field.Title and InitialsSurnameID Number0 / 13Card LimitZARSignatureStart signing your signature hereYour browser does not support e-Signature field.Total monthly purchase limit applied for *ZARBudget limit applied for *ZARDate *Upload ID Documents of Card HoldersChoose FileNo file chosenDelete uploaded fileAFFORDABILITY ASSESSMENTRequired fields marked with *Monthly IncomeGross Monthly Income *ZARUpload Proof of Income (Bank + Financial Statements)Drag and Drop (or) Choose FilesPlease attach 3 months latest bank statements and financial statementsUpload Copy of Business Registration Document *Drag and Drop (or) Choose FilesCIPRO DocumentsMonthly ExpensesAccommodation Expense: RentZARAccommodation Expense: Rates and TaxesZARAccommodation Expense: Electricity and WaterZARTransport Expense: PetrolZARTransport: MaintenanceZARCommunication: Mobile, Telkom, InternetZAROther Expenses: SpecifyZARExpense DescriptionOther Expenses: SpecifyZARExpense DescriptionOther Expenses: SpecifyZARExpense DescriptionVehicle Finance: Monthly PaymentZARVehicle Finance: Capital Amount OutstandingZARTotal Company ExpensesNet Monthly IncomeAmount Available for Pretorium Trust Card *ZARSTATEMENT OF ASSETSFixed PropertySuburbMarket ValueZARCurrent BalanceZARSuburbMarket ValueZARCurrent BalanceZARSuburbMarket ValueZARCurrent BalanceZARMovable AssetsItemMarket ValueZARItemMarket ValueZARItemMarket ValueZARDebtorsAmount OwedZAREstimated amount recoverableZARAmount OwedZAREstimated amount recoverableZARAmount OwedZAREstimated amount recoverableZARCREDIT AND PAYMENT HISTORYRequired fields marked with *Under Administration or Debt Review? *YesNoIn the past 3 months, have you applied for debt review or debt counseling or are presently under administration or debt reviewAny disputes in process with a Credit Bureau? *YesNoLost Card Protection (optional) *Yes (R12)NoThe member confirms that he is aware of the Card Protection Fund offered by Pretorium Trust and that he must apply in writing for protection under the scheme. In terms of Pretorium Trust's Protection Fund Scheme, the member accepts liability for all payments made by Pretorium Trust or which Pretorium Trust is bound to make in respect of, or arising from, any use of the card before Pretorium Trust is reasonably able to act after receipt of the written notification by the member that the card is lost or stolen. Please debit my Pretorium Trust account annually with (R12 per card) in respect of the purchase cards issued on my membership number and include my name on the list of members of the Purchase Card Safeguarding Fund.Advance Payment Fund *AgreeThe member must contribute to the Advance Payment Fund at a minimum of R25 per month to a maximum of twice the monthly purchase limit. Please debit my account monthly with R25.Other Contribution ValueSignature *Start signing your signature hereYour browser does not support e-Signature field.CONSENT AND SUBMISSIONRequired fields marked with *Do you wish to receive your statement via: *EmailPostWould you like to be considered for an automatic annual credit limit increase? *YesNoDo you choose to be excluded from telemarketing campaigns by or on behalf of the Credit Provider? *YesNoWould you like to be considered for any mass distributions of e-mails or sms messages conducted by the Credit Provider? *YesNoPromotions by the Credit Provider on behalf of our suppliersWhere did you hear about us? *Please selectMemberOnlineSocial MediaRadioPrinted MediaOtherIf referred, Member number?Preferred Payment Method? *Please selectDebit OrderOtherDebit Order Instruction(If applicable)Account Holder NameAccount NumberAccount TypeBank NameBranch NumberDate of Debit OrderLast working dayFirst working dayPlease upload Account ConfirmationDrag and Drop (or) Choose FilesSigned atDateDate application completedSignature of Account HolderStart signing your signature hereYour browser does not support e-Signature field.Debit Order approval.Cost of Credit *I agree with the membership fees as per the Cost of CreditTerms and Conditions *Yes, I agree with the privacy policy and terms and conditions. Â Signature *Start signing your signature hereYour browser does not support e-Signature field.SubmitSave as Draft
