Hire Purchase Application Form -

Hire Purchase Application

Personal Information

Name: *

Email Address: *

Date of Birth *

1st Type of ID: *

ID Number: *

Upload a scan of your ID: *

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Upload a photo of yourself for verification: *

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2nd Type of ID: *

ID Number: *

Upload a scan of your 2nd ID *

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Home Telephone: *

Cell Telephone: *

Work Telephone: *

Address: *

Proof of Address: *

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Paid bill in applicants name

Delivery Instructions: *

2nd Proof of Address:

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If different from normal address, upload a paid utility bill in Sponsor's name

Marital Status: *

Home Owner: *

Spouse Name: *

Contact Number: *

Employment Details

Employer *

Job Letter: *

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Upload Payslip *

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Job Title: *

Monthly Salary: *

Years employed with this employer: *

Current Expenses

Rent/Mortgage: *

Bank Loans: *

Other Expenses: *

Two references

1st. Reference Name: *

Address: *

Phone Number: *

Relationship: *

2nd. Reference Name: *

Address: *

Phone Number: *

Relationship: *

Additional Files

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I/we confirm that all the information provided is true and correct, and that I/we have not withheld any information that might affect Standard Distributors from making a well informed decision.

I/we authorize and give consent to Standard Distributors to receive and exchange any financial and other information which it may have with any of its subsidiaries, agents, other financial institutions, credit bureaus, or any other corporation with whom I/we may have or propose to have financial dealings from time to time.

I/we give permission for Standard Distributors Limited to obtain any credit report on my/our financial position from time to time throughout the duration of any loans being held with the organization.

I/we indemnify Standard Distributors Limited against any loss, claims, damages, liabilities, actions and proceedings, legal and or other expenses which may be directly and reasonably incurred as a consequence of the disclosure of the financial information.

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