Ackermans Account Form – Fill Out and Use This PDF

Ackermans Application Form

The Ackermans Card is underwritten and managed by Tenacity Financial Services (Reg. No. 2007/003071/07) who is a registered credit service provider (NCRCP1638). Please complete all sections of the application clearly. Applicants who are below the age of 18 years will not be considered for credit. Please hand your application together with a copy of your ID and latest payslip in at your nearest store or fax to +27 (0)21 928 1041.

For administration pur poses only:						AKS201103WA/ ENG
Store name:					Store No:
	Yes, I want to join			Yes, I would like to apply for the A- Plus Family Protector Plan.
	the A- Plus Club
				(Terms & Conditions apply - see reverse)

At which store would you like to pick up your new card?

Branch

Store No.

Personal Details

Wor k Details

Employer /

Company Name

Occupation / Job

Depar tment

Employee /

Clock No.

Manager /

Super visor Name

Manager Number

(Dial Code & Number)

Wor k Number

(Dial Code & Number)

Contact Details of someone not living with you

Title	Mr	Mrs	Ms First Name
Sur name
Contact Number

	Supplementar y Card Application
I,	hereby request a Supplementar y Card for the person stated below to

share my account and credit limit

Once the application has been approved, you will be notified via SMS. The Supplementary Card applicant can then go to any A- Plus store with their ID Book and the reference number you will receive in the confirmation SMS to collect and activate their card. The store at which the card is collected will determine which brand of card is issued – choose between Ackermans, Shoe City, Hang Ten and Jay Jays!

Title

Sur name

First Name

Known Name

Mr

Mrs

Ms

Initials

Are You?

On what day are you paid?

Years at present employer

Permanently		Self	On	Casually
Employed		Employed	Contract	Employed
	If you are on		D D M M Y	Y Y Y
D D	contract, when
	does it expire?
	Years at Previous
	employer

Brand	Branch			Store No.
Title	Mr	Mrs	Ms	Initials
Sur name
First Name

Identity/ Passpor t Number

Nationality

Gender

Mar ital Status

Number of

Dependent

Children

Please supply the following infor mation related to dependants:

	Male	Female Date of Bir th			D D M M Y		Y Y Y
	Single	Mar r ied	Divorced			Widowed
		Under the age of 18 Years
	1. Date of	D D M M Y	Y	Y	Y	Male	Female
	Bir th
	2. Date of	D D M M Y	Y	Y	Y	Male	Female
	Bir th
	3. Date of	D D M M Y	Y	Y	Y	Male	Female
	Bir th

Monthly Income & Expenses

	Your Income	Spouses Income
Gross Monthly Salary -	R	R
before deductions
Other Monthly Income	R	R

	Your Expenses	Spouses Expenses
Salary Deductions	R	R
(From Salary Slip)
Bond / Rent	R	R
Rates / Levy	R	R
Policies	R	R
(life, household insurance, funeral)

Identity Number
Cellular Number
E-Mail Address
Ethnic Group	Black	White	Coloured	Asian	Do not wish to answer
For statistical purposes
I’d like to know about exciting offers and promotions from the Ackermans					Yes	No
Group stores.
Signature of Main Cardholder			Signature of Supplementar y Cardholder
D D M M Y Y Y Y				D D M M Y Y Y Y

Consent & Acknowledgements

Mar ital Contract

Education Level

Language Preference for Cor respondence

Postal Address

Residential

Address

Number of years at present address

Province

	Community of Proper ty			Ante-nuptial	Other
	No		High		Degree
	Schooling
			School	Diploma	Post
	Pr imar y
			Matr ic		Graduate
	School
	English		Afr ikaans
				Postal Code
				Postal Code
		Number of years at
		previous address

Credit Commitments	R	R
(vehicle finance, personal loans, store accounts)
Other Household expenses	R	R
(food, schooling, transport, petrol, cell)

How many store accounts do you hold?

Banking & Debit Order Details

	What type of
	account do you	Cur rent	Savings	Mzansi	Credit Card
	cur rently hold
	(You may tick more than one)

How many years have you had your bank account?

Would you like to pay your account by debit order ?		Yes	No
Select amount to be debited:	Total Payment Due		Total Balance Due
If Yes - Name of
Account Holder

I consent to an annual limit increase

Signature

Have you made application to a debt counsellor or to be placed under administration in the last 60 days?

I’d like to know about exciting offers and promotions from the Ackermans Group stores.

Would you like to receive mar keting messages via

E- Mail Y	N	SMS	Y	N		Telemar keting Y	N	Post
I author ise	Tenacity to		disclose			my details to other	par ties to

cor respond with me regarding other products that may interest me.

By ticking YES, I author ise Tenacity to use the infor mation disclosed by me on this application, as well as my credit histor y and payment profile with any person, including the credit bureau. By ticking NO, your application cannot be processed as credit bureau infor mation is a cr itical par t of the application process.

If you are mar r ied in community of proper ty or by customar y law pr ior to 15/ 11/ 2000, then you are required to obtain the consent from your spouse to enter into this credit agreement. Please confir m that

Yes	No
Yes	No
Yes	No
Y N
Yes	No
Yes	No
Yes	No

	Home Tel. Number			if no home number please provide
				alternative (Code & Number)
	Cellular Number
	E-Mail Address
	Where do you	Own	Rented	Hostel	With
			Accomoda			Other
	live?	Home		Boarder	Parents
			tion
				What is the value of your home?
	If you own a home
				What is your outstanding bond?
	Do you own your	Yes	No
	own car ?
	Home Language	English	Afr ikaans	isiNdebele	Sesotho
		Setswana	siSwati	isiXhosa	isiZulu
		Sepedi	Tshivenda	Xitsonga	Other
	Ethnic Group	Black	White	Coloured	Asian	Do not
	(information required by					wish to
	the Credit Regulator)					answer

	Bank Name
	Account Number
	Branch Name			Branch Number
	Type of Account	Cheque /	Savings	Mzansi	Debit order	D D
		Cur rent			deduction date

Signature of account holder -

Ihereby author ise my monthly deductions to be debited to this account

	Spouses Details
Title	Mr Mrs Ms First Name
Sur name
Contact Number

you have received consent from your spouse.

By signing the application below I acknowledge that I have read, understood and accepted the Acker mans Card ter ms and conditions. I also confir m that the infor mation that I have provided is complete, cor rect and tr ue.

Signature

Date

For Branch Use

Account Number

Store Number

Application

EmployeeChecked by

Number

Acceptance of Account

By signing here I acknowledge that I have taken possession of my Acker mans Card, and have signed the card on the signature panel . I also acknowledge receipt and acceptance of the pre- agreement quote and credit agreement.

Signature

Date

Terms and Conditions of the A-Plus Revolving Credit Facility of Tenacity Financial Services (Pty) Ltd

The credit facility is granted by Tenacity that shall be governed by the following terms and conditions to which you must always adhere, as they constitute a binding agreement between you and Tenacity.

1.What we mean

1.1.‘agreement’ means, these terms and conditions as well as the pre-agreement quotation which together will constitute a credit agreement in terms of

1.‘account holder’ means the person who has applied for and has been granted a credit facility by Tenacity

1.‘account’ means the credit facility opened in the name of the account holder

1.‘credit facility’ means the total amount of credit approved by Tenacity to be utilised by the account holder for the purchase of

goods from any participating branches by utilising the card as a method of payment

1.‘card’ means the -lus plastic card issued to you, the account holder, by us, which you must use to access your credit facility

1.‘-lus’ means the card acceptance brand for the participating branches.

1.‘participating branches’ means the branches of cmans, ity, y ys and Ten tores in the epublic of outh frica and t display the -lus acceptance sign

1.‘you’ or ‘your’ includes the account holder and any additional cardholder

1.‘we’ or ‘us’ means Tenacity who is the credit provider and duly registered as such in terms of

1.1‘Tenacity’ means Tenacity inancial ervices roprietaryed egistration . redit rovider ddress adnor oad, arow ndustria

1.11.‘T’ means ‘Tenacity eference ate’ being the reference rate determined by Tenacity which shall be the ma interest rate speciied in the pre-agreement quote

1.1‘’ means tional redit ct, ct . egulations promulgated there under, as amended from time to time

pplying for a credit facility and the agreement

ny application for a credit facility is subt to our normal credit approval criteria.

y maing an application for a credit facility you are applying to enter into an agreement that shall be governed by

the terms of the agreement. We have no obligation to approve this application. The issue of a card to you will signify our approval of your application that shall be subt to the credit facility allowed by us and the terms of the agreement.

tural persons may apply for the credit facility.

We will asou for certain information before we can consider your application for a credit facility. ou must provide complete and accurate information.

We must verify your identity and may decline the application if you cannot give us satisfactory proof of your identity.

y signing for your card and using it to machases you have accepted the pre-agreement quote and these terms and conditions.

our card

our card is the access to your credit facility.

ou must sign your card in inou receive it. se the space provided at the bacd.

The accountholder may have additional cards lino the account if application for these additional cards

has been approved by us. The accountholder will be liable for all amounts owing through the use of the main and additional cards.

dditional cardholderree to be held tly and severally liable as co-principal debtoror all amounts accountable through the use of the additional card.

The issue of additional cards will not increase the credit limit we allow on the credit facility. Tenacity will always remain the owner of the card.

our credit facility

We decide the credit limit on the account y be varied from time to timeou must ensure that you and any additional cardholders do not eceed this limit.

We have the right to reduce or cancel your credit facility at any time of which you shall be notiied. We may refuse to authorise purchases through using your credit facility for any reason whatsoever,

including if you have eceeded your credit limit.

f we accept to process a transaction that results in you eceeding your credit limit, it does not mean that we

have etended or increased your credit limit. ny such etension will be a temporary increase of your credit limit in order to allow the speciic transaction.

our credit limit

ou may, by written notice, aso reduce your credit limit.

ou may, by written notice, authorise us to apply annual increases to your credit limit, or withdraw that authorisation. ny increase of your credit limit will be in our sole discretion.

ou may not may purchases or obtain any services that will cause you to eceed your allocated credit limit. We may, within our sole discretion and at any time, reduce the credit limit allocated to your account. our credit limit will be relected on your monthly statement.

sing your card

count holder in whose name the card has been issued may use the card.

The card may only be used at any participating branch. The list of participating branches may be changed from time to time, which will be communicated to you.

ou may use the card to pay for goods and services at any participating branch.ou must sign a transaction slip when maing a purchase.

ou may not use the card for any other transactions.

We will not be liable if any participating branch refuses to accept or honour your card when maing a purchase. ou wish to return your purchase to any participating branch, such returnt to the

participating branch’s standard returns policy.our account will be credited with the amount of the purchase returned provided such return is in accordance with the standard returns policy of and accepted by the participating branch.

ou acnowledge and agree that your use of the card may be suspended anderminated at any time for any

reason whatsoever and that we shall have no liability of whatsoever nature and howsoever arising in consequence of any such suspension andermination.

afeised use of your card

ou are responsible for the safeoper use of your card.

tely at the Tenacity ervice entre on our card is lost or stolen.

We will stop further transactions on the card as soon as is reasonably possible after being advised that the card is lost or stolen.

ou will be responsible for all transactions made with the card before we stop future transactions on the card in terms of ou have authorised such transactions.

ou will nevertheless be responsible for all transactions made with the card after you have reported your card as lost or stolen if –

your signature appears on the voucher, sales slip or similar record of the participating branch

other evidence, to our satisfaction, is obtained which indicates you authorised or were responsible for the particular use of the credit facility after the card was reported lost or stolen.

alfunction of electronic facilities

We are not responsible for any loss arising from any failure, malfunction or delay in any electronic point of sale device, erminal, or our supporting or shared networ, where applicable, resulting from circumstances beyond our reasonable control.

uthority to debit your account

our account will be held with Tenacity and administered at our ape Town oices.

ou will remain liable for any amount owing on the account until it is credited by instalments actually received and cleared.

ny purchases from participating branches using the card, will be charged to the account, whether or not the transaction slip of the participating branch has been signed by you.

We will not be liable if a transaction processed at a participating branch is not authorised by you and you will remain liable for any amount that has been debited to the account as a result of a transaction of this nature.

1ayment schedule

1The pre-agreement quotation which has been presented to you together with these terms and conditions, sets out the information relating to the credit etended to you, the frequency of payments, the number of payments, the date of the irst and last payment, all of which assumes mation of the credit facility granted to you.

1our acceptance of the pre-agreement quotation, the pre-agreement quotation together with these terms

and conditions shall constitute a binding contract between you and us, and the pre-agreement quotation shall be deemed to form part of these terms and conditions as the payment schedule required pursuant to the

11.nterest and other charges

11.1.t to the provisions and limitations of the e will determine the monthly service fees and interest rate,

which will apply to your account and show this detail on your monthly statement. We are entitled to levy services fees at the mathly rate as permitted in terms of the The initial monthly service fees will

be disclosed at the time of your application for a credit facility.

11.The interest rate is a variable rate that is lino the To that rate may result in changes to the rate at which interest is charged on your account.

11.ou will be advised within ys through your statements of changes to the interest rate.

11.nterest will be calculated on a daily basis and compounded monthly on the full outstanding balance of your account from time to time. This interest is then added monthly to the outstanding balance of your account.

11.Tenacity reserves the right to charge an account initiation fee which will be disclosed to you upon application for a credit facility.

1The monthly statement and payment

1We will send you a statement every month to your postal address or electronically if this delivery method has been selected by you. The statement will show all transactions made on the account up to the date of the statement.

1The statement will show both the full and minimum amounts payable to us, on or before the due date shown on the statement.

1ou must advise the Tenacity ervices entre in writing or telephonically at the numbers referred to in

days of the date of the statement should you believe the statement to be incorrect. therwise it will be deemed that the statement is correct.

1ou should contact the Tenacity ervice entre should you not receive a monthly statement. ailure to receive a monthly statement will not entitle you to refuse or fail to pay any amount that is due on the account.

1We may verify and conirm any record of a payment into the account. ur records will be taorrect unless the contrary is proved by you.

1The account will be credited immediately with any payment made into it, but the credit facility will only be increased once the payment has been cleared.

1ll payments to your account will irst go towards the payment of interest, then to service fees and charges, and inally to the principal debt.

1ou must pay at least the minimum amount as well as any arrears relected on your statement by the due date.

1ou may also repay any amount owing at any time, notwithstanding the instalment relected on your statement.

1ou may pay at any participating branch, or any other facility that we communicate to you from time to time.

1f you fail to comply with your payment terms or any other of the conditions of the agreement, or your estate is sequestrated, or you pass away, or you maes in the application process, then all amounts will, at

our election, become due and payable immediately and your credit facility will be closed.

1The method of payment that you choose will be at your own rise will only recognise the payment when we receive and process it and once it has been cleared.

1egal and other osts

1f your account goes into arrears or if you are in breach of any other provision of the agreement then we may ta any or all of the following actions

1you will be charged with default administration charges relating to any debt collection activities which will include letters and telephone calls made through the month whilst you are in arrears which will not eceed the limits allowed in terms of

1your default status will be noted on the credit bureau which could negatively afect your credit record

1we will suspend your credit facility and give you notice that we intend to close your account on which your full balance will become immediately due and payable

1your account will be handed over to an eternal debt collection agency for the recovery of the amount in arrears and you will be charged with these costs.

1f we institute legal action against you, you will be liable for all legal costs, which will include but not be limited to legal costs on an attorney and client scale, all collection and tracing costsevenue stamps and sherif costs, and related value added tages. These will be debited to your account.

1t may also be taou.

1ertiicate of ndebtedness

ertiicate signed by any of our managers whose appointment and authority need not be proven, in which the amount of your indebtedness to us and the interest rate applicable to your credit facility is stated, shall be accepted as prima facie proof of your indebtedness in any legal proceedings and shall be regarded as correct unless you prove the contrary.

1onsent to isdiction

n terms of section agistrates’ ourts ct, ou hereby consent that we may institute any legal

proceedings that have to do with this agreement or your account, in any agistrate’s ourt, which in terms of section agistrates’ ourts ct, has isdiction over you. We can however choose to institute action

against you in any other courts having isdiction.

1our options

1t is acnowledged that, in terms of your application for a credit facility, you have been presented with a choice of selecting any of the following options –

1to decline an option of pre-approved annual credit limit increases as provided for in section 11

1to be ecluded from any –

1telemarn that may be conducted by or on behalf of us

1maromer list that may be sold or distributed by us, other than as required by the

1any mass distribution of email or sms content.

1nformation consent

ou, the account holder, consent to us

1maing enquiries about your credit record with any credit reference agency and any other party to conirm the details on your credit application

1providing regular updates regarding the conduct of the account to the credit reference agencies and allowing the credit reference agencies to in turn maecord and details available to other credit grantors

1checing your payment behaviour, at any time, by referencing your credit record with any credit reference agency

1listing your details with any credit reference agency should you default on your repayment obligations to Tenacity

1carrying out identity and fraud prevention checing information relating to your credit application with

other credit grantors

1providing details to other credit grantors of any conduct on your account that gives us reasonable cause to suspect that the accounts are being used for improper purposes.

1reement – by you tion 1

ou may, at any time, end this agreement and pay the settlement amount to us. ou must advise us in writing if you want to close

and settle your account. ou must destroy y cutting through the magnetic stripe and account numbereturn the cardo

us with your letter. d that is not destroyed correctly may still be used and should this happen you will be responsible for the payment of all transactions that may tae.

1	reement – by Tenacity tion 1

1f you are in default of this agreement, we may taeps set out in the oncerns debt enforcement by repossession or to enforce and terminate this agreement.

1n addition we may –

1suspend your credit facility

1close the credit facility granted to you by giving written notice to you at least ten business days before the credit facility will be closed

1revoour card or close the account to protect our interests.

1t our request you must immediately pay to us the total balance outstanding on the account, including accrued interest and outstanding service fees, if we revoour card or close the account.

1ven if this agreement ends, we will be entitled to rely on the rights acquired under this agreement before it ended.

1withstanding any suspension, cancellation andermination, this agreement shall remain in efect to the

etent necessary until you have paid all amounts outstanding to us.

1We may not close or terminate your credit facility solely on the grounds that –

1we have declined your request to increase the credit limit

1you have declined an ofer from us to increase the credit limit

1you have requested a reduction in your credit limit, unless such a reduction reduces the credit limit to a level at which we would not ordinarily ofer or establish credit.

onsequences of termination

The unilateral termination of this agreement by us does not suspend or terminate any residual obligations we may have to you under this agreement.

ly settlement tion 1

ou are entitled to settle the account by requesting us to close your account and cancel your card at any time with or without advance notice to us.

The amount required to settle the account would be the unpaid balance of the principal debt owing to us at that

time together with the unpaid interest and all other service fees and charges payable by you to us up to the settlement date.

mendments to terms and conditions

ther than speciically reserved in terms of these terms and conditions, Tenacity may generally introduce amendments to these terms and conditions subt to the ou will be notiied in writing. ny such amendments will be efective twenty-one days after we have sent the proposed amendments to you. f you are dissatisied with the amendments you may invoovisions of 1ve.

ddresses for notices

The physical address you provide when applying for the credit facility will be regarded as your chosen address where notices may be given and documents in legal proceedings may be served.ou must notify us in writing immediately if your chosen address changes. tion should be mailed to oarow

-mailed to acmansenacityinc.co.

ou should send any legal notice to us at our chosen address provided above.

eneral

outh frican law governs these terms and conditions.

ny indulgence or concession we may give you will not afect any of our rights against you. We monitor and record all our telephone calls and other interactions with you.

We may cede, assign or transfer our rights and obligations under this agreement or arrange for any other person to carry out any of our rights or obligations under this agreement without your consent and without notice to you.

ou have the right to resolve a complaint by way of alternative dispute resolution as provided for in the

ou have the right to apply to a debt counsellor for debt review or to be declared over-indebted. n this regard, the tional redit egulator can be contacted for debt counsellors’ details at

ou must immediately tell us if you are under an administration order, become insolvent, or have any other form of legal disability.

ou can ile any credit related complaints with the tional redit egulator at mation to the tional redit Tribunal.