Application Form

Complete the form below or download a pdf copy here & we will contact you.



Personal Information (Single Applicant)

First Names Surname
Identity Number Physical Address
Post Code Postal Address
Post Code Cell Tell. (H)
Tell. (W) Email

Income and Expenses (Single Applicant)


Monthly Gross Salary
Monthly Salary Deductions
Monthly Nett Income
Monthly Other Income
Bank & Branch Name (Banking Details)
Referral Agent





Personal Information (Spouse/Joint)

First Names Surname
Identity Number Physical Address
Post Code Postal Address
Post Code Cell Tell. (H)
Tell. (W) Email

Income and Expenses (Spouse/Joint)


Monthly Gross Salary
Monthly Salary Deductions
Monthly Nett Income
Monthly Other Income
Bank & Branch Name (Banking Details)

I/We do hereby nominate, constitute and appoint LUCID Legal Business Services (Pty) Ltd (2003/016694/07) (“LUCID”) with Power of Substitution to be my/our true and lawful Agent in my/our name, place and stead, to represent me/us and deal with any matter and sign all documents necessary, to obtain my/our consumer credit information, finance application and financial information, from all credit bureaus and relevant third parties and to make the aforementioned information available to me/us and Omega Mortgage, for the purpose of the latter performing an affordability and pre-qualification finance assessment on me/us.

I agree to LUCID contacting me/us to provide me/us with a copy of my/our affordability, financial and risk assessment reports and a consultation to assist me/us in qualifying for finance or qualifying for better borrowing terms or improving my/our affordability and risk.

I accept that LUCID will retain all my/our information, received in terms of this authority and I consent to its use thereof, for any processing purpose within the normal course of its business, as may be determined, from time to time, at its sole discretion.

I understand that I may revoke this authorization, in writing to LUCID, at any time and unless revoked, it shall remain in force and effect.

First Names Residential Address
Surname Marital Status
ID Number Email
Home Phone Work Phone
Mobile Employer
Occupation

Income & Expenses


Salary (Income) PAYE (Expenses)
Commissions (Income) UIF (Expenses)
Overtime (Income) Pension (Expenses)
Car Allowance (Income) Medical Aid (Expenses)
Maintenance (Income) Food & Groceries (Expenses)
Subsidies (Income) Insurances (Expenses)
Rental Income Rent or Bond (Expenses)
Investment Income Telephone (Expenses)
Interest Income Lights, Water, Rates, Taxes (Expenses)
Other monthly income Telephones, Cellphones (Expenses)
Car Instalments (Expenses) Petrol (Expenses)
Loans, Personal (Expenses) Other monthly expenses

Assets & Liabilities


Fixed Property (Assets) Home Loan (Liabilities)
Vehicle (Assets) HP Facility (Liabilities)
Cheque Acc (Assets) Overdraft (Liabilities)
Investment (Assets) Retail Acc (Liabilities)
Pers. Loans (Liabilities)

Banking Details


Account Type Account No (Banking Details)
Monthly Expenses (excluding credit instalments)