Shop Trading Name:

Names:

Surname:

Are you the legal owner:

ID Number\Passport Number(Foreigner):

Contact Number:

Cell Number:

Email:

Shop Address:

Suburb:

Town:

Province:

Postal Code:

Shop Type:

 

I/we hereby give permission to ITHUBA Holdings Proprietary Limited (RF) and its selected agencies to perform credit and/or any other probity checks required using the information provided by me. By completing this pre-application I/we acknowledge that I/we have read and understand the terms and conditions of this pre-application and agree to be bound thereby.