Credit Application Form - Scania

4. PERSON AUTHORISED TO TRANSACT ON BEHALF OF COMPANY / CLOSE CORPORATION / TRUST / CLIENT/PARTNERSHIPFull NamesID NumberCountry of CitizenshipTitle/Role in companyResolution to be provided (Compulsory)Physical Address(Not company address-residential address)Telephone No. Area Code: Number: E-Mail address:Cell No5. BANKING DETAILSNumber:Signature:Account NameBANKBRANCH CODE /BRANCH NAMEACCOUNT NUMBEROVERDRAFT LIMIT6. INSURANCEDid one of Scania Representatives explain Scania Insurance to you?Do you have your own InsuranceY / NY / NCan Scania Insurance give you a Quote Y / N Customer signature – Confirm Insurance was discussed7. CONSENTWe, the applicant, hereby give Scania Finance consent:1. to supply Scania SA – Credit Department with all financial information as supplied toallow Scania SA to quote on Repair & Maintenance and to consider an openaccount;2. to do the necessary Credit and Kreditinform checks from time to time;3. to list the applicant in the event of default with any credit bureau at the sole discretionof Scania Finance;4. to cede any claim by the applicant’s insurer;5. to provide updated financials and ancillary information on demand and/or in the eventthat any of the information provided herein changes;6. to approach the applicant’s vehicle tracking service provider without prior consent toestablish the whereabouts of the vehicles which form the subject matter of thisapplication.Customer signatureWe declare that no judgment has been obtained against the applicant or its directors or trustees in the last five years.We warrant that this application constitutes our actual financial position, and we are capable of fulfilling the liabilities arisingfrom this application.The facts and figures herein contained are current, true and correct and may be relied upon by Scania Finance.Scania Finance reserves the right to approve or decline the application as per their approved Credit Policy.No agreement between the parties will be enforceable unless reduced to writing and signed by all parties.Please refer to Annexure “A” for the comprehensive list of application requirements as well as requirements dictated by FICA.Please note that this application will not be considered if it is not signed by theapplicant/s.City: ___________________________ Date: _____________________________Signature: _________________________Company stamp:Who hereby warrants his authority to sign on behalf of the CO/CC/Trust/PartnershipCONTACTS:Northern & Eastern RegionWikus Jordaan082 808 8851wikus.jordaan@scania.co.za(011) 822 3962 FaxInsurance Coordinator:Kevin Meyer082 317 4840kevinm@scania.co.za(011) 908 7023 FaxVersion 3 – Feb 2013Gauteng Region Gauteng:Rikus Gouws079 510 5379rikus.gouws@scania.co.za(011) 908 7023 FaxAlicia Weldon082 317 9249alicia.weldon@scania.co.za(011) 822 3962 FaxBennie Vorster (Bus / Fleet)082 808 8852barend.vorster@scania.co.za(011) 908 7023 FaxCentral & Free State Region:Leon Kriel083 642 5556leon.kriel@scania.co.za(086) 625 1294 FaxKZN & Eastern Cape Region:Suren Naicker082 825 2975surendra.naicker@scania.co.za(031) 705 8088 FaxWestern & Northern Cape Region:Rupert Klynsmith071 670 9431rudolph.klynsmith@scania.co.za(021) 987 0230 FaxPage 3 of 4