APPLICATION FOR A STUDENT LOAN
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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NOTE: Please complete in BLOCK LETTERS
Tick (✓) applicable block(s) and complete where necessary
New application
Preapproval
Increase in an existing loan
Takeover loan
PART A: STUDENT DETAILS
Title (Mr/Mrs/Miss/Dr, etc)
Surname
Identity no
First name(s)
Date of birth (ddmmyyyy)
Gender:
Male
Female
Race (for statistical purposes):
Black
Coloured
Indian
White
RSA resident?
Yes
No
If 'No', country of residence
Do you have tax obligations, tax liabilities or tax residencies outside of South Africa?
Yes
No
Are you a US citizen, a US person or a US national?
Yes
No
Marital status:
Single
Married out of community of property
Married in community of property
Divorced
Widowed
Contact details
Tel (w)
Tel (h)
Cell
Fax
Email address
Preferred contact no:
Home
Work
Cell
Are you an emancipated minor?
Yes
No
If 'No', are you assisted by your guardian?
Yes
No
ADDRESS DETAILS
Residential address
Postcode
Postal address
Postcode
Period at this address (years)
Period at previous address (years)
Residential status:
Live with partner
Live with parents
Own property
Rent property
EMPLOYMENT DETAILS
Income category:
Salary earner
Contract worker
Student
Other
Present employer
Occupation
Employed since
Number of years at previous employer
Industry
SPOUSE DETAILS
(Please complete if married in community of property.)
Title (Mr/Mrs/Miss/Dr, etc)
Surname
Identity no
First name(s)
LOAN DETAILS
Total loan amount
R
Indicate the total loan amount paid to you to date in terms of the student loan agreement:
R
Additional amount required
R
Please provide a breakdown of the loan amount required in the budget table below:
Tuition fees
Books
Accommodation
Equipment
Total
Less own resources
Loan amount
Total for the year
R
R
R
R
R
R
R
Note
• Fulltime students: Monthly payments for interest, fees and, if applicable, insurance on the loan amount are payable from the month following disbursal of the loan
amount.
• Parttime students: Monthly instalments (calculated on the loan amount, interest, fees and, if applicable, insurance) are payable from the month following disbursal
of the loan amount.
INITIATION FEE (complete only if first loan)
Do you wish to pay the initiation fee upfront or do you wish to include it in the loan?
Upfront
Include in loan
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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ACADEMIC DETAILS
Student status:
Parttime
Fulltime
Accommodation:
Residence
Private
Student no
Educational institution
Field of study
Major subject
Year of study
Expected final year
If the applicant is a fulltime student, the income and expenditure table (part C) must be completed by the surety. If the applicant is a parttime student without
a surety and is employed, the income and expenditure table (part C) must be completed by the applicant.
OTHER STUDY LOANS
Institution
Loan amount
R
Balance outstanding
R
CREDIT LIFE INSURANCE
Credit life insurance is optional.
Do you choose to have credit life insurance?
Yes No
If 'Yes', please tick the appropriate option:
We will arrange this for you.
You will arrange your own insurance.
Note: Ensure that the insurance option was discussed with the applicant and hand the last two pages of this application form to the client.
PAYMENT HISTORY (Student)
Are you currently under or have you applied for debt review?
Yes
No
Do you have any rearrangement in place with a credit provider as a result of debt counselling?
Yes
No
Do you have any dispute in progress with a credit bureau?
Yes
No
Do you have a curator bonis?
Yes
No
Are you under administration?
Yes
No
If you are married in community of property, is your spouse currently under or has he/she ever applied for debt review?
Yes
No
PART B: SURETY DETAILS
Title (Mr/Mrs/Miss/Dr, etc)
Surname
Identity no
First name(s)
Date of birth (ddmmyyyy)
Gender:
Male
Female
Race (for statistical purposes):
Black
Coloured
Indian
White
RSA resident?
Yes
No
Marital status:
Single
Married out of community of property
Married in community of property
Divorced
Widowed
Contact details
Tel (w)
Tel (h)
Cell
Fax
Email address
Preferred contact no
Home
Work
Cell
Are you an emancipated minor?
Yes
No
If 'No', are you assisted by your guardian?
Yes
No
ADDRESS DETAILS
Residential address
Postcode
Postal address
Postcode
Period at this address (years)
Period at previous address (years)
Residential status:
Live with partner
Live with parents
Own property
Rent property
EMPLOYMENT DETAILS
Income category:
Salary earner
Contract worker
Student
Other
Present employer
Occupation
Employed since
Number of years at previous employer
Industry
BANKING DETAILS
Bank
Branch
Type of account
Account no
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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SPOUSE DETAILS
(Please complete if married in community of property.)
Title (Mr/Mrs/Miss/Dr, etc)
Surname
Identity no
First name(s)
As the spouse of the aforementioned surety, I consent to my spouse (the surety) binding himself/herself as surety and coprincipal debtor to
Nedbank Limited for the amount specified in the suretyship for facilities granted to the principal debtor on the form usually used by Nedbank for this
purpose.
Signed by spouse
at
on
/
/
Signature
Place
Day
Month
Year
Witness 1
Witness 2
Signature
Signature
Name
Name
PAYMENT HISTORY (Surety)
Are you currently under or have you applied for debt review?
Yes
No
Do you have any rearrangement in place with a credit provider as a result of debt counselling?
Yes
No
Do you have any dispute in progress with a credit bureau?
Yes
No
Do you have a curator bonis?
Yes
No
Are you under administration?
Yes
No
If you are married in community of property, is your spouse currently under or has he/she ever applied for debt review?
Yes
No
PART C: INCOME AND EXPENDITURE TABLE
INCOME
EXPENDITURE (Household)
Gross monthly basic salary
R
Total property rental/home loan instalment*
R
Estimated future revenue from business (if sole
proprietor)
R
Vehicle
R
Travel/Car allowance
R
Personal loans
R
Housing subsidy/allowance
R
Overdraft
R
Medical aid allowance
R
Credit cards
R
Reimbursements
Clothing accounts
R
Fuel
R
Furniture accounts
R
Cellphone/Telephone
R
Other loans
R
Other
R
Rates, taxes, water and electricity
R
Commission
Groceries and clothing
R
Month 1
R
Domestic wages
R
Month 2
R
Telephone and cellphone(s)
R
Month 3
R
Entertainment and DStv
R
Overtime
R
Fuel and maintenance
R
Sick pay
R
Short-term insurance
R
Leave pay
R
Life insurance and annuities
R
Bonus
R
Investments and savings
R
Other income
Education and school fees
R
Maintenance
R
Medical expenses (excluding medical aid
contribution)
R
Additional income
Other
R
Net pension
R
R
Net disability grant
R
R
Other (specify)
R
R
Gross property rental income
R
Total income
R
Total monthly expenditure
R
Deductions
PAYE
R
* Where the declared amount is less than the monthly home loan instalment
reflected in the credit bureau data/home loan agreement, I warrant that the amount
is my contribution to the monthly instalment and that my spouse/the other party or
parties to the joint home loan is/are responsible for the remaining part of the
instalment.
UIF
R
Medical aid
R
Pension/Provident fund
R
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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Group insurance
R
Industrial Council contributions
R
Union fees
R
Total deductions
R
Net salary
R
Total income
R
Less total expenditure
R
Surplus/Deficit
R
LEGAL AND GENERAL INFORMATION
While Nedbank Group Limited and all its subsidiaries, associates, cessionaries, delegatees and successors in title (collectively 'Nedbank') are
constantly striving to provide a service that is intended to make your banking as easy and convenient as possible, all South African banks are legally
obliged to verify and retain information received from you. This includes identity verification with statutory bodies. Apart from the information you will
provide in this form, Nedbank may therefore require additional documentation and information from you.
PRIVACY CONSENT
I provide Nedbank with my express consent to process my personal information as defined in legislation, including fingerprints, biometric personal
identification details, photographs and identity verification in terms of the Financial Intelligence Centre Act, 38 of 2001, for purposes of providing
financial services and preventing fraud and money laundering, and to send my personal information to third parties in order to provide a service to
me, and also to send such information to foreign countries, when necessary, by electronic or other means for processing. I understand that such
countries may not have specific data privacy laws. I further consent to Nedbank using my personal information to monitor and analyse my consumer
behaviour.
COMMUNICATION AND MARKETING
1 In order to assist me to achieve my financial goals, Nedbank* may contact me from time to time with information that
meet my needs.
Yes
No
2 I would like Nedbank to present exclusive offers from other organisations to me.
Yes
No
3 Nedbank may request reputable research organisations to contact me.
Yes
No
4 My preferred method(s) of communication is/are:
Email
SMS
Direct mail
Telephone
All
5 Nedbank may use a method of communication other than that preferred by me as well as my personal information to
market its products to me, including electronic marketing and telesales, until I give an instruction to the contrary.
Yes
No
* 'Nedbank' refers to Nedbank Group Limited and all its subsidiaries and associates and its cessionaries, delegatees and successors in title.
FURTHER PROCESSING
1 Nedbank may search, update or place my records at credit reference bureaus and government agencies in order to verify my identity, assess
my ability to obtain credit or to provide collateral of any kind, including guarantees or suretyships, and may, on request from another credit
provider with whom I have applied for credit, give my personal information, including my credit reference data, to such credit provider and also
make any enquiries that it deems necessary to confirm the details on this form for marketing purposes and to assess my creditworthiness.
2 Nedbank may use my personal information for debt enforcement, including recovery, collection, repayment, surrender, enforcement and cession
of debts.
3 I confirm that I have fully disclosed my debt repayment history.
ELECTRONIC SIGNATURE CONSENT
I acknowledge and agree to be bound by the agreement by my electronic signature and I am uniquely identified by my signature. A copy of the
signed agreement will be emailed and/or handed to me for my record. Nedbank will store and archive the electronically signed agreement.
CONFIRMATION
1 Nedbank has explained this application form, the product and costs, where applicable, to me and I confirm that I fully understand the contents
thereof and that I am completing it of my own free will.
2 I warrant that I have fully and truthfully answered all questions and responded to requests for information as part of the assessment process,
and that I am not aware of any other information that may affect this application negatively.
3 Nedbank may undertake identity and fraud prevention checks and share information relating to this application with the Southern African Fraud
Prevention Service.
4 All consent provided in this document will survive any contractual relationship that I have with Nedbank, unless I provide Nedbank with written
notice that I have cancelled such consent.
5 Nedbank may obtain my account statements from financial institutions for the purpose of assessing this loan application, whether electronically
or otherwise.
Note: The consultant who assisted you with this loan application is not entitled to charge you any fees or commission.
Signed at
on
/
/
Place
Day
Month
Year
By student
Signature
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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By legal guardian
(If student is under
the age of 18)
Signature
By surety
Signature
Witness
Signature
Name
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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SUMMARY OF THE STUDENT LOAN PROTECTION
PLAN
This document is a summary of the Student Loan Protection Plan. For any additional information please refer to the full policy document.
In simple terms, it will give you important contract information and help you understand:
• Why you should take credit life insurance
• what you are covered for;
• how much it will cost you;
• what your responsibilities are;
• how the claims process works;
• when this insurance policy will not pay out; and
• what your rights are.
Why you should take credit life insurance
This insurance product is specifically designed to cover the cost of your student loan debt if you are no longer able to pay your instalments due to
death or disability. The cover protects your loved ones from the strain of having to settle your debt.
What am I covered for?
The Student Loan Protection Plan provides credit life cover. This means that should you be unable to complete your studies or earn an income after
you have completed your studies, Nedbank Insurance will pay back your student loan, so your family wouldn't have to worry about it.
• The claim amount will be paid to Nedbank to settle your outstanding loan if you:
− die; or
− become totally and permanently disabled.
You will be regarded as disabled if:
you are prevented, due to injury, surgical operation or disease, from:
o completing your studies; or
o following the occupation for which you have qualified (if you have completed your studies, but have not yet repaid the full
outstanding loan amount)
for six consecutive months after the disabling event. Your premiums must still be paid during these six months, and at the end of this
period, we must be convinced that your disablement is total and permanent.
OR
you have suffered the loss of:
o the use of both hands or both feet or one of each; or
o the sight of both eyes
for six consecutive months after the event having caused the loss. Your premiums must still be paid during these six months, and at
the end of this period, we must be convinced that your disablement is total and permanent.
OR
you have suffered the loss of the use of one hand or one foot or the sight of one eye by external, violent means or due to an
accident.
• The amount paid out for each of these events will be the lump sum benefit equal to your outstanding loan amount.
• The insurance cover starts on the day your student loan is approved.
• Your cover will come to an end when your loan is settled or the policy is discontinued.
• The disability cover will automatically come to an end when you turn 33.
• The death cover will automatically come to an end when you turn 75.
How much will it cost me?
The premium payable is calculated at a rate of R0,35 per R1 000 of the outstanding balance of the student loan. So, the more you pay off on your
loan, the less you pay for insurance.
What are my responsibilities?
Nedbank Limited will deduct the premium automatically from your account and pay it to Nedgroup Life Assurance Company Limited. However, it is
your responsibility to check your bank statements to make sure that the premiums are paid correctly.
Nedbank Ltd Reg No 1951/000009/06. Authorised financial services and registered credit provider (NCRCP16).
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How does the claims process work?
• Should you have a claim under your policy, you must notify our Claims Department within 180 days of the claim event:
Tel: 0860 333 111
Fax: 0860 065 437
Email: claims@nedgrouplife.co.za
• The necessary forms can be collected from the Nedbank branch where your account is held.
• Claims must be submitted in writing.
• All necessary proof must be submitted with your claim (this may not necessarily be restricted to proof of death or disablement). Nedgroup Life
Assurance Company Limited may require further medical examinations at its expense.
Claim payments
In the event of a claim the outstanding balance of your student loan will be paid into your student loan account.
When will this insurance not pay out?
We will not consider claims arising (directly or indirectly) from or traceable to:
• your being affected (temporarily or otherwise) by alcohol or drugs (unless prescribed by a medical practitioner); or
• your committing a criminal offence; or
• intentional self-inflicted injury; or
• your committing suicide in the first 12 months of the policy; or
• any condition, physical defect, illness, bodily injury or disability that you were aware of and received medical advice or treatment for in the
12 months before taking out this policy; or
• your participating in war, riots, civil commotion, terrorism or military action.
What are my rights?
• You have a 'cooling-off period' of 31 days from the date on which you receive your policy documents during which you may cancel this policy
and receive a refund of all premiums that have already been paid. However, this will be allowed only if no benefit has been claimed or paid in
terms of this policy.
• If you have any complaints, please submit it in writing to our Client Services Centre. The contact details are provided below.
Important contact information
Disclaimers:
This document serves as a guide only and does not replace the policy document. Please refer to the policy document for the full terms and
conditions.
Nedbank Limited (Reg No 1951/000009/06) is the proposer and policyholder, and you – the person who has taken out a loan for which this policy
provides cover – are the insured person.
Nedgroup Life Assurance Company Limited is an authorised financial services provider.
Nature of
enquiry
Contact
Company
Telephone
Fax
Email address or website
General
enquiries
Client Services
Contact Centre
Nedgroup Life
PO Box 149175
East End
4018
0860 333 111
0860 065 435
clientservices@nedgrouplife.co.za
Claims
Claims
department
Nedgroup Life
PO Box 149175
East End
4018
0860 333 111
0860 065 437
claims@nedgrouplife.co.za
Compliance
Compliance
officer
Nedgroup Life
PO Box 149175
East End
4018
031 536 5010
0860 066 641
compliance@nedbankinsurance.co.za
Regulatory
enquiry
Public officer
Nedgroup Life
PO Box 149175
East End
4018
0860 333 111
0860 065 435
publicofficer@nedbankinsurance.co.za
Complaints in
respect of
claims or other
matters not
resolved
satisfactorily
Long-term
Insurance
Ombudsman
Long-term
Insurance Ombud
Office
Private Bag X45
Claremont
7735
086 010 3236
021 674 0951
FAIS
complaints
(relating to
financial service
provided)
FAIS
Ombudsman
FAIS Ombud
Office
PO Box 74571
Lynnwood Ridge
Pretoria
0040
012 348 3447
0860 324 766
www.faisombud.co.za
