Consent

 
 

Please note that you need to complete this form in one session and submit as you cannot save any information you have provided.

 
 

By proceeding online, you accept our terms and conditions for social media and internet use. This constitutes a binding agreement between you and Iemas.

 
 
I Accept*
 
 
 

I understand that by accepting, I am consenting to Iemas, for the processing, storing and sharing of my personal information.

 
 
I Consent*
 
 
 

Where I provide personal information about or on behalf of another person, eg my spouse, partner or relative, I confirm that I have obtained their consent and I am authorised to provide their personal details.

 
 
I Confirm*
 
 
 

I hereby authorise Iemas to submit data to a credit bureau about this application, opening and termination of this account, to obtain personal information concerning myself from any credit bureau at any time to assess my application for credit, my level of indebtedness and my debt repayment history, and to inform a credit bureau regarding my non compliance with the terms and conditions of this agreement.

 
 
I Authorise*
 
 
 

I consent that any employee of Iemas may approach my current employer in order to obtain confirmation of my employment details, or any other required information applicable to my membership and obligations towards Iemas.

 
 
I Consent*
 
 
 

 
 
 
I am not insolvent.*
 
 
 
I am not under (or have applied for) debt review.*
 
 
 
I am or have not applied for sequestration.*
 
 
 
I have not been declared mentally unfit by any Court.*
 
 
 

 
 
 
I consent to receiving of Direct Marketing from Iemas:*
 
Yes
No
 
 
I consent to receiving of General Communication from Iemas:*
 
Yes
No
 
 
I consent to receiving of telemarketing from Iemas:*
 
Yes
No
 
 
Means of Correspondence:*
 
 
 

To find out more, click on our privacy notice.

To find out more, click on our terms and conditions.

For more information on access to any information we hold, click on our PAIA Manual.

 
 
 
 

Personal Information

 
 
Member Number
 
 
 
ID or Passport*
 
ID Number
Passport Number
 
 
 
ID Number*
 
 
 
 
Passport Number*
 
 
 
 
Full Names*
 
 
 
Initials*
 
 
 
Surname*
 
 
 
Title*
 
 
Other*
 
 
 
Nationality*
 
 
Other*
 
 
 
Ethnic Group*
 
 
Other*
 
 
 
Gender*
 
 
 
 
Residential Address*
 
 
State / Province / Region*
 
 
 
City / Town*
 
 
Zip / Postal Code*
 
 
 
I choose my residential address as my address where I accept all notices and documents relating to this agreement (domiclium citandi et executandi)*
 
 
 
 
Postal Address*
 
 
State / Province / Region*
 
 
 
City / Town*
 
 
Zip / Postal Code*
 
 
 
Years At Present Address*
 
 
Number Of Dependants Living With You*
 
 
 
Which one of the following applies with regards to your residence?*
 
 
Preferred Language*
 
 
 
Educational Level*
 
 
 
 
 

Contact Details

 
 
Phone Number (H)*
 
 
Cell Number*
 
 
 
E-Mail*
 
 
 
 
 

Employment Information

 
 
Employer Name*
 
 
 
Job Title*
 
 
 
Date of Employment*
 
 
Phone Number (W)*
 
 
 
Date Salary Received*
 
 
Employee Number*
 
 
 
 
 

Marital Status

 
 
Marital Status*
 
 
Other*
 
 
 
Date Of Marriage*
 
 
Antenuptial Contract*
 
 
 
Date Of Divorce*
 
 
 
 

Spouse / Partner Information

 
 
Full Names*
 
 
 
Surname*
 
 
 
ID Number*
 
 
 
Employer Name*
 
 
Date Of Employment*
 
 
 
Phone Number*
 
 
Cell Number*
 
 
 
E-Mail*
 
 
 
Residential Address*
 
 
State / Province / Region*
 
 
 
City / Town*
 
 
Zip / Postal Code*
 
 
 
 
 

Details Of Relative

 
 
Full Names*
 
 
Surname*
 
 
 
Relationship*
 
 
Cell Number*
 
 
 
Phone Number*
 
 
E-Mail*
 
 
 
Residential Address*
 
 
State / Province / Region*
 
 
 
City / Town*
 
 
Zip / Postal Code*
 
 
 
Years At Present Address*
 
 
 
 
 

Method Of Payment

 
 
Method Of Payment*
 
 
 

Statement

 
 
How Would You Like To Receive Your Statement*
 
 
 
Means Of Marketing Correspondence 
SMS*
 
 
 
 
E-Mail*
 
 
 
May We Provide Your Personal Information To Third Parties*
 
 
 

Banking Details

 
 
Bank*
 
 
 
Branch Name*
 
 
Branch Code*
 
 
 
Account Number*
 
 
Account Type*
 
 
 
I consent to Debicheck as collection method (if applicable) and will provide my co-operation to give effect to the Debicheck mandate.*
 
 
 
 
 
 

Select the products you are interested in:

 
 
Vehicle Finance*
 
 
 
Agreement Type*
 
 
 
Nature Of Transaction*
 
 
New Or Pre-Owned Vehicle*
 
 
 
Description Of Vehicle*
 
 
 
Year Of First Registration*
 
 
Dealer Name*
 
 
 
Phone Number*
 
 
 
 
Application Amount*
 
 
Balloon Percentage*
 
 
 
Deposit*
 
 
Term (Months)*
 
 
 
Credit Life Insurance*
 
 
Coverplus*
 
 
 
Iemas Warrantee*
 
 
Dealer Warrantee*
 
 
 
Housing Solutions*
 
 
 
Are You The Owner Of The Property*
 
 
Is This Your Primary Residence*
 
 
 
Description Of Improvement*
 
 
 
Address Of Property To Be Renovated*
 
 
State / Province / Region*
 
 
 
City / Town*
 
 
Zip / Postal Code*
 
 
 
Pension Fund Name*
 
 
Pension Fund Number*
 
 
 
Income Tax Number*
 
 
 
 
Loans*
 
 
 
Loan Type*
 
 
Loan Amount*
 
 
 
Loan Term (Months)*
 
 
 
 
 
 

Expenses

 
 

Current Credit Obligations:

 
 
Vehicle Repayment*
 
 
Unsecured Loan Repayment*
 
 
 
Minimum Credit Card Repayment*
 
 
Bond Repayment*
 
 
 
Furniture Account Repayment*
 
 
Clothing Account Repayment*
 
 
 
Overdraft Repayment*
 
 
Short-Term Insurance Premium*
 
 
 
Other*
 
 
 
 

Necessary Living Expenses:

 
 
Accommodation (Rent)*
 
 
Transportation*
 
 
 
Food / Groceries*
 
 
Education*
 
 
 
Medical (Not On Payslips)*
 
 
Municipal Account (Water and Electricity)*
 
 
 
Maintenance (Child)*
 
 
 
 

Discretionary Expenses:

 
 
Telephone Expenses*
 
 
TV / DSTV Expenses*
 
 
 
Entertainment Cost*
 
 
Domestic Worker(s)*
 
 
 
Other Expenses*
 
 
 
 
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