Application: purchase order finance. Application: Purchase Order Finance. fill out the form Please only fill out this form if you were referred to The X Quotient by a particular person. If you were not referred by anyone, please fill out the form on this page: https://thexquotient.com/application-form/ APPLICATION: PURCHASE ORDER FINANCE - REFERRALPlease enable JavaScript in your browser to complete this form.DETAILS OF REFERRALPlease specify the Name and Surname of the person who referred you to The X Quotient *FirstLastPlease specify the Phone Number of the person who referred you to The X QuotientAPPLICATION FORMPlease indicate amount of financing required (R) *BUSINESS INFORMATION Company Name *Company Registration Number *Company Type *Sole proprietorshipPartnership(Pty) Ltd or CCOtherBusiness Number *Business Email Address *EmailConfirm EmailVAT NumberIncome Tax NumberDate Business Commenced: *Business Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePostal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeHow long have you been at this address?DIRECTORS OF THE COMPANYIf you have more than 4 directors in your company, please email us at pieter@thexquotient.comPlease indicate the number of directors in the company:123425% OR MORE SHAREHOLDERSPlease complete the details of all shareholders who hold 25% or more of the shares of the company below.Please complete the details of all shareholders who hold 25% or more of the shares of the company below.Full Name & SurnameShareholder 1 DetailsFull Name & SurnameShareholder 2 DetailsFull Name & SurnameShareholder 3 DetailsFull Name & SurnameShareholder 4 DetailsID NumberID NumberID NumberID NumberPercentage HoldingPlease enter percentage.Percentage HoldingPlease enter percentage.Percentage HoldingPlease enter percentage.Percentage HoldingPlease enter percentage.PERSONAL CONTACT INFORMATION - DIRECTOR 1TitleDirector 1Full Names *Director 1Surname *Director 1Country of Citizenship *Director 1ID/Passport Number *Director 1Residential Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 1Postal Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 1Cell Phone Number *Director 1Email Address *EmailConfirm EmailDirector 1Marital Status *SingleMarriedDirector 1Marriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageDirector 1Please provide your spouse's full name and surname:Director 1: Married - In Community of PropertyPlease provide your spouse's ID number:Director 1: Married - In Community of PropertyPlease provide your spouse's email address:Director 1: Married - In Community of PropertyPlease provide your spouse's phone number:Director 1: Married - In Community of PropertyHave you ever been declared insolvent / sequestrated? *NoYesDirector 1Please provide more information.Director 1Are you or any of your immediate family members employed by any governmental body? *NoYesDirector 1Please provide more information.Director 1PERSONAL CONTACT INFORMATION - DIRECTOR 2TitleDirector 2Full NamesDirector 2SurnameDirector 2Country of CitizenshipDirector 2ID/Passport Number *Director 2Residential AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 2Postal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 2Cell Phone NumberDirector 2Email AddressEmailConfirm EmailDirector 2Marital StatusSingleMarriedDirector 2Marriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageDirector 2Please provide your spouse's full name and surname:Director 2: Married - In Community of PropertyPlease provide your spouse's ID number:Director 2: Married - In Community of PropertyPlease provide your spouse's email address:Director 2: Married - In Community of PropertyPlease provide your spouse's phone number:Director 2: Married - In Community of PropertyHave you ever been declared insolvent / sequestrated? *NoYesDirector 2Please provide more information.Director 2Are you or any of your immediate family members employed by any governmental body? *NoYesDirector 2Please provide more information.Director 2PERSONAL CONTACT INFORMATION - DIRECTOR 3TitleDirector 3Full NamesDirector 3SurnameDirector 3Country of CitizenshipDirector 3ID/Passport Number *Director 3Residential AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 3Postal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 3Cell Phone NumberDirector 3Email AddressEmailConfirm EmailDirector 3Marital StatusSingleMarriedDirector 3Marriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageDirector 3Please provide your spouse's full name and surname:Director 3: Married - In Community of PropertyPlease provide your spouse's ID number:Director 3: Married - In Community of PropertyPlease provide your spouse's email address:Director 3: Married - In Community of PropertyPlease provide your spouse's phone number:Director 3: Married - In Community of PropertyHave you ever been declared insolvent / sequestrated?NoYesDirector 3Please provide more information.Director 3Are you or any of your immediate family members employed by any governmental body?NoYesDirector 3Please provide more information.Director 3PERSONAL CONTACT INFORMATION - DIRECTOR 4TitleDirector 4Full NamesDirector 4SurnameDirector 4Country of CitizenshipDirector 4ID/Passport Number *Director 4Residential Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 4Postal AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDirector 4Cell Phone NumberDirector 4Email AddressEmailConfirm EmailDirector 4Marital StatusSingleMarriedDirector 4Marriage TypeMarried - In Community of PropertyMarried - ANC With AccrualMarried - ANC Without AccrualCustomary MarriageDirector 4Please provide your spouse's full name and surname:Director 4: Married - In Community of PropertyPlease provide your spouse's ID number:Director 4: Married - In Community of PropertyPlease provide your spouse's email address:Director 4: Married - In Community of PropertyPlease provide your spouse's phone number:Director 4: Married - In Community of PropertyHave you ever been declared insolvent / sequestrated?NoYesDirector 4Please provide more information.Director 4Are you or any of your immediate family members employed by any governmental body?NoYesDirector 4Please provide more information.Director 4BANK DETAILSBank Name *Branch Code *Account Number *Type of Account *Savings CurrentOtherDetails of all Current Loans or SuretiesIs the company currently involved in or have any pending litigation against it?Is the company under Business rescue or intend entering Business rescue proceedings in the next 3 months? *NoYesPURCHASE ORDER TRANSACTION INFORMATIONProcuring Entity *Physical Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCell Phone Number *Email Address *EmailConfirm EmailPurchase Order Value *Purchase Order Number *Purchase Order Expiry DateHave you supplied this customer before? *YesNoHave you been to the customer’s premises? *YesNoDOCUMENTATION REQUIREDCompany Registration Documentation - CIPC COR14.3 or CK2 * Click or drag a file to this area to upload. Certified Copies of all Director’s ID’s (Not older than 3 months) * Click or drag files to this area to upload. You can upload up to 4 files. FICA proof of residence for Directors (Not older than 3 months) * Click or drag files to this area to upload. You can upload up to 4 files. FICA proof of residence for the Company (Not older than 3 months). Bank Statement etc. * Click or drag files to this area to upload. You can upload up to 4 files. SARS Tax clearance certificate – Company and Individuals Click or drag a file to this area to upload. If applicable, proof of CSD Summary Registration Report Click or drag a file to this area to upload. Copies of Purchase Orders including full item specifications. * Click or drag files to this area to upload. You can upload up to 10 files. Copies of Supplier quotes/invoices for goods to be supplied. * Click or drag files to this area to upload. You can upload up to 10 files. Bank Account Confirmation Letter Click or drag files to this area to upload. You can upload up to 10 files. Please attach a selfie of each director holding their ID document next to their face. Please make sure both the face and ID details are clearly visible. * Click or drag files to this area to upload. You can upload up to 10 files. Terms & ConditionsPlease read through all important information and confirm below. (Link to privacy policy at bottom of page). *I have read and understand the Declaration, Authority to Conduct Credit Search and the Privacy Policy below.LayoutSubmit Application