POLICY/INSURANCE REPAYMENT *

TELEPHONE PAYMENT *

TRANSPORT COST *

FOOD & ENTERTAINMENT *

EDUCATION COSTS *

MAINTENANCE *

HOUSEHOLD EXPENSES *

OTHER *

TOTAL MONTHLY HOUSEHOLD EXPENSES *

HOUSEHOLD SURPLUS/DISPOSABLE INCOME *

ARE YOU CURRENTLY LIABLE AS *

SPECIFY DETAILS

If you have signed or Co-Debtor, please include the full amount outstanding

I CONFIRM THAT: *

I am not a minor

I CONFIRM THAT: *

I am not under sequestration

If any of the above is incorrect, please provide details:

DECLARATION BY CLIENT

I hereby grant the Owner or Rental Agent of EZlend Wheels the right to communicate with me through any electronic / written media or verbally to make available to me, their product offering and to utilize my information for supporting products as communicated by one of the Credit Provider’s Partner. *

Yes

No

I hereby declare that all information provided above is true and correct *

Yes

FULL NAME *

DATE *

DECLARATION BY CLIENT

EZ Wheels South Africa is here.

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