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Absa Bank Limited/Beperk, Reg No 1986/004794/06

Application for Study Loan/Aansoek om Studielening


CSA Ref CSA-verw

Preferred Student Bureau Voorkeurstudenteburo I the undersigned (Mr, Mrs, Miss, etc) Ek, die ondergetekende (Mnr, Mev, Mej, ens)

Site code Perseelkode

(Full names of Customer/Volle name van Klint)

Identity number Identiteitsnommer Existing study loan number Bestaande studieleningnommer Student Personal Computer offer Rekenaaraanbod vir die Studentemark YES JA NO NEE If YES, complete ABSA 3701 Indien JA, voltooi ABSA 3701 Life insurance premium added Lewensversekeringspremie ingesluit YES JA NO NEE

hereby apply for a student loan for the amount of doen hiermee aansoek om n studentelening ten bedrae van

NEXT OF KIN NAASBESTAANDES


Name and surname Naam en van Address Adres Telephone numbers (please include home, work and cell) Telefoonnommers (sluit asb huis, werk en sel in) Whats the relationship? Wat is die verwantskap?

STUDENTS STUDY COURSE INFORMATION STUDIERIGTINGINLIGTING VAN STUDENT


Student number Studentenommer Study course Studierigting Changed course of study Studierigting verander Diploma Diploma Honours Honneurs Degree Graad Masters Meesters YES JA NO NEE Educational Institution Opvoedkundige instelling If YES, give details Indien JA, verskaf besonderhede Duration of study course Tydsduur van studierigting Full-time student Voltydse student Part-time student Deeltydse student

Present academic year Huidige akademiese jaar Doctorate Doktoraat Board exam Raadseksamen

PARTICULARS OF STUDENT BESONDERHEDE VAN STUDENT


Mr Mnr Full first names Volle voorname ID number ID-nommer Relationship to Customer Verwantskap met Klint Mrs Mev Miss Mej Surname Van

BANK ACCOUNT INFORMATION/BANKREKENINGINLIGTING (For payment of loan/Vir betaling van lening)


Accounts at financial institutions other than Absa Bank Limited? Rekeninge by ander finansile instansies as Absa Bank Beperk? Branch Tak Account number Rekeningnommer If YES, total liabilities of other student loans Indien JA, totale verpligting tov ander studentelenings Name of financial institution Naam van finansile instansie Occupation Beroep 1 Occupational status Beroepstatus 5 Present employment since Huidige werk sedert Full-time employed Voltyds in diens Student 2 Self-employed (professional) Eie werkgewer (professioneel) 7 Pensioner Pensioenaris 8 3 Self-employed (non-professional) Eie werkgewer (nie-professioneel) 9 Temporarily employed Tydelik in diens 4 10 Housewife Huisvrou Scholar Skolier Branch Tak YES JA NO NEE If YES, which Bank? Indien JA, watter Bank? Account type Tipe rekening Other student loan(s)? Ander studentelening(s)? YES JA NO NEE

R
Account number Rekeningnommer

6 Unemployed Werkloos

Part-time employed Deeltyds in diens

C/E C/E Y/J

Y/J

ABSA 3561 BX (NCA)

Authorised Financial Services Provider/Gemagtigde Finansilediensteverskaffer Registered Credit Provider/Geregistreerde Kredietverskaffer, Reg No NCRCP7

ABSA (02/12/2009)

FIXED PROPERTY DETAILS BESONDERHEDE VAN VASTE EIENDOM


Registered in the name of Geregistreer in die naam van Description of property Beskrywing van eiendom Self Spouse Gade Both Beide Joint other Present residential address since Saam ander Huidige residensile adres sedert Realistic market value Realistiese markwaarde

C/E C/E Y/J

Y/J

Date purchased Datum aangekoop

Purchase price Aankoopprys

Bondholder, if applicable Outstanding balance Verbandhouer, indien van toepassing Uitstaande saldo

LIFE AND ENDOWMENT ASSURANCE (excluding Retirement Annuities) LEWENS- EN UITKEERVERSEKERING (Uittredingsannuteite uitgesluit)
Number of life/endowment policies Getal lewens-/uitkeerpolisse Total sum assured Totale versekerde bedrag Available as security? If so, please furnish details Beskikbaar as sekuriteit? Indien wel, verstrek asseblief besonderhede Name of company Naam van maatskappy Policy number Polisnommer Date issued Datum uitgereik Monthly premium Maandelikse premie Year in which oldest policy was issued Jaar waarin oudste polis uitgereik is

PAYMENT AUTHORISATION/DEBIT ORDER INSTRUCTION IN RESPECT OF STUDENT LOAN BETALINGSMAGTIGING/DEBIETORDERINSTRUKSIE TOV STUDENTELENING
Full names of accountholder Volle name van rekeninghouer Account number Rekeningnommer Account type Tipe rekening Name of bank Naam van bank Branch clearing code Takverrekeningskode *Capital repayment *Kapitale terugbetaling Interest payable on Rente betaalbaar op *Not compulsory Cheque Tjek Savings Spaar Transmission Transmissie

Per month on or after per maand op of na

Of each month van elke maand Of each month van elke maand

LOAN DEBIT AUTHORITY LENINGSDEBIETMAGTIGING


Study Loan Account number Studieleningsrekeningnommer TRANSFER OF FUNDS OORPLASING VAN FONDSE To account number Na rekeningnommer Bank Account name Rekeningnaam Reference number Verwysingsnommer To account number Na rekeningnommer Bank Account name Rekeningnaam Reference number Verwysingsnommer CONDITIONS 1 This authorisation shall remain in force at any other branch of Absa Bank Limited to which either or both of the above accounts shall be transferred. 2 This authorisation shall remain in force until the expiry date specified above or until the authorisation shall be cancelled by me within 30 (thirty) days prior notice in writing. Amount Bedrag R Branch Tak Amount Bedrag R Branch Tak

VOORWAARDES 1 Hierdie magtiging sal van krag wees by einge ander tak van Absa Bank Beperk waarheen enigeen of beide van bogenoemde rekenings oorgeplaas word. 2 Hierdie magtiging bly van krag tot op die vervaldatum hierbo vermeld of totdat die magtiging deur my met 30 (dertig) dae skriftelike vooraf kennis gekanselleer word.

Date/Datum Signature of accountholder/Handtekening van rekeninghouer

M C/E Y/J Y/J Y/J

I/We acknowledge that the information supplied by me/us shall constitute the basis on which my/our application is to be considered and that all such information is of material importance and directly relevant to the consideration of my/our application. I/We warrant that all information I/we supplied is to the best of my/our knowledge and belief true and correct in all material respect and I/we is/are not aware of any other information which, should it become known to the Bank, would affect the consideration of my/our application in any way. I/We agree that the Bank may make inquiries to confirm any information provided by me/us and that the Bank may obtain information from any credit bureau when assessing my/our application or at any time during the existence of my/our account. The Bank may disclose the existence of my/our account to any credit bureau, sharing positive and negative information about my/our account. Absa Bank Limited (Absa), a member of the Banking Council of South Africa, wishes to inform you that all information regarding your personal and financial matters is treated as strictly confidential. To enable the Absa Group to offer you a full range of services and products suited to your needs, we require your consent to utilise your personal information within the Group and to communicate to you on an on-going basis through the Group or our contracted agents.

Ek/Ons bevestig dat die inligting wat ek/ons verskaf het die grondslag uitmaak waarop my/ons aansoek oorweeg sal word en dat alle sodanige inligting van wesenlike belang is en regstreeks betrekking het op die oorweging van my/ons aansoek. Ek/Ons waarborg dat al die inligting wat ek/ons verskaf het na my/ons beste wete en oortuiging in elke opsig waar en korrek is en ek/ons is nie bewus van enige ander inligting wat, indien die Bank daarvan te wete sou kom, die oorweging van my/ons aansoek enigsins sal benvloed nie. Ek/Ons stem in dat die Bank navrae kan doen om enige inligting te bevestig wat ek/ons verskaf en dat die Bank enige inligting van enige kredietburo kan bekom wanneer my/ons aansoek beoordeel word of te eniger tyd gedurende die bestaan van my/ons rekening. Die Bank kan die bestaan van my/ons rekening aan enige kredietburo bekend maak en positiewe en negatiewe inligting oor my/ons rekening met hulle deel. Absa Bank Beperk (Absa), n lid van die Bankraad van Suid-Afrika, wil u graag inlig dat al die inligting oor u persoonlike en finansile aangeleenthede streng vertroulik behandel word. Om die Absa Groep in staat te stel om aan u n volledige reeks dienste en produkte te bied wat by u behoeftes pas, het ons u toestemming nodig om u persoonlike inligting binne die Groep te gebruik en om deurlopend met u deur die Groep of ons gekontrakteerde agente te kommunikeer.

Please tick () the appropriate box I hereby withhold consent and fully understand the implications and ramifications of my/our decision and will not hold Absa Group responsible for financial advice and offers that I/we have not received. I hereby consent to the above Customer Communications and Consent

Merk () asseblief die toepaslike blokkie Ek weerhou toestemming en verstaan ten volle die implikasies en gevolge van die besluit en sal die Absa Groep nie verantwoordelik hou vir finansile advies en aanbiedings wat ek/ons nie ontvang het nie. Ek gee hiermee toestemming tot bogenoemde

The Absa Group diligently guards all personal and financial information relating to our customers. Your dealings with us are held in the strictest confidence and your privacy as an Absa customer is one of our highest priorities. At Absa, we do not sell or distribute any of our customer lists to third parties, unless we are required to do so by law. In keeping with this commitment, we need your consent to send you information on the Absa Groups range of products and services as well as any special promotions from us, or promotions on behalf of other carefully selected parties, which we believe would add value to your finances or lifestyle. We might also contact you to conduct research in order for us to improve our products and services to you. If you would like us to communicate with you in this regard from time to time, please complete the form below: Absa Marketing Consent I/We do want the Absa Group to utilise my/our confidential information within the Group and to communicate with me/us from time to time regarding products, services, research and special offers that they believe will be of interest. I am / we are happy to receive such communication via the following communication methods (Please tick whichever apply): Post Telephone SMS E-mail

I/We do not want to receive any communication from the Absa Group on products, services or special offers and understand that this means that I/we will not be kept informed of products and services that may be of value to me/us. I/We will therefore not hold the Absa Group liable for any opportunities I/we may miss as a result of this decision. Creditworthiness information Absa is occasionally approached by credit providers or third parties who are attempting to evaluate your creditworthiness when you apply for credit or wish to enter into a credit agreement with such a party. We cant give them this information without your permission to do so. I/We give Absa permission to provide information relating to my credit score or creditworthiness to third parties who may request this information. I/We do not give Absa permission to provide information relating to my credit score or creditworthiness to any third parties who may request this information.

Klintkommunikasie en Toestemming Die Absa Groep beskerm all persoonlike en finansile inligting oor ons klinte baie nougeset. U sake met ons word streng vertroulik hanteer en u privaatheid as n Absa-klint bly een van ons hoogste prioriteite. By Absa word ons klintlyste nie aan derde partye verkoop of versprei nie, tensy dit regtens van ons vereis word. In ooreenstemming met hierdie onderneming, benodig ons ook u toestemming om inligting aan u te stuur oor die Absa Groep se reeks produkte en dienste, asook oor enige van ons spesiale promosies, of promosies namens ander sorgvuldig geselekteerde partye, welke inligting waarde tot u finansies of leefstyl sal toevoeg. Ons kan u ook skakel in verband met ons navorsing ter verbetering van produkte en dienste wat ons aan u lewer. Voltooi asseblief die vorm hieronder indien u wil h dat ons van tyd tot tyd hieroor met u kommunikeer. Absa-bemarkingstoestemming Ek/Ons wil graag h dat die Absa Groep my/ons vertroulike inligting binne die Groep benut en van tyd tot tyd met my/ons kommunikeer oor produkte, dienste, navorsing en spesiale aanbiedinge wat hulle van belang ag. Ek/Ons wil graag sodanige kommunikasie ontvang, via die volgende kommunikasiemetodes (merk wat ook al van toepassing is): Pos Telefoon SMS E-pos

Ek/Ons wil nie kommunikasie van die Absa Groep oor produkte, dienste of spesiale aanbiedinge ontvang nie en verstaan dit beteken dat ek/ons nie ingelig sal word oor produkte en dienste wat vir my/ons van waarde kan wees nie. Ek/Ons hou dus nie die Absa Groep aanspreeklik vir enige geleenthede wat ek/ons as gevolg van hierdie besluit kan verbeur nie.

Inligting oor kredietwaardigheid Absa word soms deur kredietverskaffers of derde partye genader wat poog om u kredietwaardigheid te beoordeel wanneer u om krediet aansoek doen of n kredietooreenkoms met sodanige partye aangaan. Ons kan hierdie inligting nie sonder u toestemming aan hulle gee nie. Ek/Ons gee Absa toestemming om inligting oor my/ons kredietgradering of kredietwaardigheid te verskaf aan derde partye wat hierdie inligting kan aanvra. Ek/Ons gee Absa nie toestemming om inligting oor my/ons kredietgradering of kredietwaardigheid te verskaf aan derde partye wat hierdie inligting kan aanvra nie.
Signed at Geteken te on op

_______________________________________________
Signature of Customer/Handtekening van Klint

_______________________________________________
Date/Datum

CONSENT OF SPOUSE MARRIED IN COMMUNITY OF PROPERTY FOR CREDIT AGREEMENT(S) AS REQUIRED BY THE MATRIMONIAL PROPERTY ACT, 1984 (Act No 88 of 1984) TOESTEMMING VAN EGGENOOT GETROUD BINNE GEMEENSKAP VAN GOED VIR KREDIETOOREENKOMS(TE) SOOS BEPAAL DEUR DIE HUWELIKS EIENDOMSWET, 1984 (Wet No 88 van 1984) Full names of spouse Volle name van eggenoot Identity number of spouse Identiteitsnommer van eggenoot WITNESSES GETUIES Date Datum

M C/E C/E Y/J Y/J

Signature of spouse Handtekening van eggenoot

1
(Signature of witness) (Handtekening van getuie)

2
(Signature of witness) (Handtekening van getuie)

(ID no) (ID-no)

(ID no) (ID-no)

(Initials and surname in block letters) (Voorletters en van in blokletters)

(Initials and surname in block letters) (Voorletters en van in blokletters)

OFFICE USE/KANTOORGEBRUIK
Date client identified Datum klint gedentifiseer Date client verified Datum klint geverifieer Method of verification Verifikasiemetode Sales consultants name Verkoopskonsultant se naam Tracking number Opsporingsnommer

D D

D D

M M

M C/E C/E Y/J Y/J M C/E C/E Y/J Y/J

Identified by: Employee number Gedentifiseer deur: Werknemernommer Verified by: Employee number Geverifieer deur: Werknemernommer Account/Reference number Rekeningnommer/Verwysingnommer E-mail/Memo ID E-pos/Memo-ID Branch and Site code Tak en Takkode