Pannar Application Form

9. INDIVIDUAL

Full names and surname: This field is required.

Identity number: This field is required.

Marital status:

Single Community of Property Antenuptial Contract with Accrual Antenuptial Contract without Accrual

Please select an option.

Have you ever been declared insolvent?

Yes No

Have you signed surety for a person or instance?

Yes No

Attach a copy of identity document:

10. PUBLIC COMPANY

Name of company:

Registration number:

Listed/Unlisted:

Listed Unlisted

Attach copies of the registration documents:

11. GOVT/SEMI GOVT/CORPORATION

Name of establishment:

Name of project:

Responsible party for payment of the account:

Contact person:

Contact number of contact person:

12. OTHER LEGAL ENTITY

Type of entity:

Partnership Private Company Co-operative Close Corporation Trust

Name of legal entity:

Name of subsidiaries:

Attach relevant documents (Partnership Agreement, Registration Documents, etc.):

13. NAMES AND ADDRESSES OF PARTNERS / DIRECTORS / MEMBERS / TRUSTEES

13.1

Full names: Relationship with the Customer: Address: Tel. No.: Identity number:

14. APPLICATION

To open account:

Open Account Renewal of Credit Facility

Please select an option.

15. EXISTING ACCOUNT

Do you have an existing account with the Seller?

Yes No

16. CONTACT DETAILS AND OTHER PARTICULARS

Postal address: This field is required.

Telephone number: This field is required.

E-mail address:

Mobile number:

Physical address / Trading address / Registered address / Farm name (Not postal address): This field is required.

Magisterial District:

VAT Reg. Number:

VAT Certificate attached:

Yes No

Name of Bank:

Name of Bank Manager:

Branch:

Bank Account Number:

Previous supplier of similar product:

Previous similar product purchases: Fully paid?

Yes No

Total annual usage (volume):

17. CREDIT FACILITY

Credit facility required for similar product purchases $-R$:

Maximum amount of a single order $-R$:

18. PURPOSE OF CREDIT

The purpose of the credit applied for is:

19. TRADE REFERENCES

Institution	Town	Telephone nr.	Account nr.	Contact person

20. PARTICULARS OF IMMOVABLE PROPERTY

Property Description	Total valuation Currently (R)	Value of Bonds	Bondholder	Registered Owner	Size

21. PARTICULARS OF MOVEABLE ASSETS

Complete description of asset	Purchase price of asset	Particulars of financier	Balance due in respect of financing	Current estimated value of asset

22. PARTICULARS OF ALL SHARES AND/OR MEMBERS' INTEREST

Entity	Description	Number	Present value	Total

23. OTHER INCOME

Source	Amount	Due date

24. DIVIDENDS

Source	Amount	Due date

25. TAX REBATES AND/OR REFUNDS

Description	Amount	Due date

26. PARTICULARS OF ALL CREDIT AGREEMENTS CONCLUDED

Credit Provider	Description of Agreement	Date	Total Amount	Payments	Balance

27. PARTICULARS OF ALL OTHER CREDITORS

Creditor	Total Amount	Payments	Date of payments	Security held	Arrears	Balance

28. JURISTIC PERSON DETAILS

Annual turnover of the Customer:

Asset value of the Customer:

29-30. LANGUAGE PREFERENCE

The Customer confirms that he/she/they has/have received this document in the official language of his/her/their choice, which he/she/they is/are able to read and understand.

Afrikaans English

7. AUDITOR DETAILS

Name, address and telephone number of auditor:

Permission is hereby granted to the financial department of the Seller to obtain my/our latest audited statements from my/our auditor.

Yes

Permission is hereby granted to the financial department of the Seller to contact my/our bank manager should any additional information be required, for example a bank code.

Yes

SIGNATURE AND DATE

Signed at: This field is required.

Date of this application: This field is required.

Signature of the Customer or a duly authorised representative: This field is required.

Name (PLEASE PRINT): This field is required.

Position:

Witness 1 Full names:

Witness 2 Full names:

DEED OF SURETYSHIP

Surety 1 Full Names:

Surety 1 Physical Address:

Surety 1 Identity Number:

Surety 2 Full Names:

Surety 2 Physical Address:

Surety 2 Identity Number:

Surety 3 Full Names:

Surety 3 Physical Address:

Surety 3 Identity Number:

Witness Full Names:

Witness Physical Address:

Signed at: <不

Item added to your cart

APPLICATION FOR CREDIT FACILITIES

9. INDIVIDUAL

10. PUBLIC COMPANY

11. GOVT/SEMI GOVT/CORPORATION

12. OTHER LEGAL ENTITY

13. NAMES AND ADDRESSES OF PARTNERS / DIRECTORS / MEMBERS / TRUSTEES

13.1

14. APPLICATION

15. EXISTING ACCOUNT

16. CONTACT DETAILS AND OTHER PARTICULARS

17. CREDIT FACILITY

18. PURPOSE OF CREDIT

19. TRADE REFERENCES

20. PARTICULARS OF IMMOVABLE PROPERTY

21. PARTICULARS OF MOVEABLE ASSETS

22. PARTICULARS OF ALL SHARES AND/OR MEMBERS' INTEREST

23. OTHER INCOME

24. DIVIDENDS

25. TAX REBATES AND/OR REFUNDS

26. PARTICULARS OF ALL CREDIT AGREEMENTS CONCLUDED

27. PARTICULARS OF ALL OTHER CREDITORS

28. JURISTIC PERSON DETAILS

29-30. LANGUAGE PREFERENCE

7. AUDITOR DETAILS

SIGNATURE AND DATE

DEED OF SURETYSHIP

Language

Language

APPLICATION FOR CREDIT FACILITIES

9. INDIVIDUAL

10. PUBLIC COMPANY

11. GOVT/SEMI GOVT/CORPORATION

12. OTHER LEGAL ENTITY

13. NAMES AND ADDRESSES OF PARTNERS / DIRECTORS / MEMBERS / TRUSTEES

13.1

14. APPLICATION

15. EXISTING ACCOUNT

16. CONTACT DETAILS AND OTHER PARTICULARS

17. CREDIT FACILITY

18. PURPOSE OF CREDIT

19. TRADE REFERENCES

20. PARTICULARS OF IMMOVABLE PROPERTY

21. PARTICULARS OF MOVEABLE ASSETS

22. PARTICULARS OF ALL SHARES AND/OR MEMBERS' INTEREST

23. OTHER INCOME

24. DIVIDENDS

25. TAX REBATES AND/OR REFUNDS

26. PARTICULARS OF ALL CREDIT AGREEMENTS CONCLUDED

27. PARTICULARS OF ALL OTHER CREDITORS

28. JURISTIC PERSON DETAILS

29-30. LANGUAGE PREFERENCE

7. AUDITOR DETAILS

SIGNATURE AND DATE

DEED OF SURETYSHIP

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