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+27-011-336-9732
sales@bouticano.com
011 336 9732
Name
Known As
Surname
ID Number
Date of Birth
Physical Address
Work Address
Contact Number(Home)
Contact Number(Cell)
Email *
Employer
Department
Position
Employee number
Duration
Job Title
Contact Details
Gross salary
Net salary
Date of pay
Bank
Account number
Branch code
How many years or months your salary has been deposited in this account?
How did you hear about Bouticano Finance?
Name of person referred
Name of relative or family member?
Contact details of relative or family member
Are you listed on ITC
If Yes, do you know who listed you?
Do you have garnish?
Revolving loan
Fixed loan
Initiation fee
Did you understand?
Credit score *
Limit granted *
Any disputed amount in the last 3 months?
Personal Information
Employment
Salary
Banking Details
Other Credit Providers
installments
Other Credit Provides
Referrals
If Yes, How much are you paying per month?
Has the Consultant Explained the following?
Office Use Only
Date
Review Date
Rent
School
Transport
Groceries
Accounts
Expenses
CLIENTS PERSONAL INFORMATION
Fixed Loan
Initiation Fee
Did you understand