Home About Us Gallery Finance Form Sell Your Car Contact Us Home About Us Gallery Finance Form Sell Your Car Contact Us Contact Us 406 Victoria Rad xaviersauto@outlook.cm 071 866 4998 Xavier’s Auto – Vehicle Finance Made Simple Xavier’s Auto provides a smooth, hassle-free vehicle finance experience built on clarity, trust, and convenience, guiding customers from vehicle selection through to finance that suits their budget. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 9GOODS DESCRIPTION - AS PER VEHICLE QUOTE Make of Vehicle *Model of Vehicle *MnM CodeCash Price incl *Delivery FeeExtras Total Selling Price *NextPERSONAL DETAILS Title *Title MrMrsYour Full Name *FirstLastID Number *Gender *Your GenderMaleFemaleMarital Status *Marital StatusSingleMarriedDivorcedSeparatedWidowedMaried ANC/COP Work Phone NumberDate of MarriageHome Phone NumberCell Phone Number *Email Address *EmailConfirm EmailYour Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryNumber of Years Residing at Current Address *PreviousNextEMPLOYER DETAILS Employer Name *Employer Phone Number *Work Period *Occupation *Employer Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPreviousNextNEXT OF KIN (NOT LIVING WITH YOU) Your Full Name *FirstLastRelationship *Cell Phone Number *Email Address PreviousNextBOND DETAILS Bank Name Outstanding BalanceInstalment Amount PreviousNextBANKING DETAILS Bank Name *Account Number *Account Type *ChequeSavingsBranch Code *PreviousNextSALARY DETAILS Gross Salary Gross SalaryNet Salary Net Salary *Overtime Overtime Layout Address Layout ADDITIONAL INCOME (IF ANY) Additional Income Amount Additional Income AmountSource of Additional Income Source of Additional IncomeHOUSING & LIVING EXPENSES Bond Instalments Bond Instalments Rent Instalments Rent InstalmentsMUNICIPAL & UTILITIES Rates, Water & Electricity Rates, Water & ElectricityTelephone / Mobile Payments Telephone / Mobile PaymentsCREDIT & FINANCIAL COMMITMENTS Vehicle Instalments (Excluding vehicle to be settled) Vehicle Instalments (Excluding vehicle to be settled)Credit Card Repayments Credit Card RepaymentsOverdraft Repayments Overdraft RepaymentsClothing Accounts Clothing AccountsFurniture Accounts Furniture AccountsINSURANCE, TRANSPORT & FAMILY COSTS Policy / Insurance Repayments Policy / Insurance RepaymentsTransport Costs Transport CostsEducation Costs Education CostsMaintenance MaintenanceHOUSEHOLD & LIFESTYLE EXPENSES Household Expenses Household ExpensesFood & Entertainment Food & EntertainmentOther Monthly Expenses Other Monthly ExpensesPreviousNextSPOUSES EXPENSES Does this apply to you? *YesNoIf no leave details below blank, If yes please fill in this form Title *Title MrMrsYour Full Name *FirstLastGross Salary Your Spouse Gross SalaryNet Salary Your Spouse Net SalaryADDITIONAL INCOME (IF ANY) Additional Income Amount Your Spouse Additional Income AmountSource of Additional Income Your Spouses Source of Additional IncomeHOUSING & LIVING EXPENSES Bond Instalments Your Spouse Bond Instalments Rent Instalments Your Spouse Bond Instalments MUNICIPAL & UTILITIES Rates, Water & Electricity Your Spouse Rates, Water & ElectricityTelephone / Mobile Payments Your Spouse Telephone / Mobile PaymentsCREDIT & FINANCIAL COMMITMENTS Vehicle Instalments (Excluding vehicle to be settled) Your Spouse Vehicle Instalments (Excluding vehicle to be settled)Credit Card Repayments Your Spouse Credit Card RepaymentsOverdraft Repayments Your Spouse Overdraft RepaymentsClothing Accounts Your Spouse Clothing AccountsFurniture Accounts Your Spouse Furniture AccountsINSURANCE, TRANSPORT & FAMILY COSTS Policy / Insurance Repayments Your Spouse Policy / Insurance RepaymentsTransport Costs Your Spouse Transport CostsEducation Costs Your Spouse Education CostsMaintenance Your Spouse MaintenanceHOUSEHOLD & LIFESTYLE EXPENSES Household Expenses Your Spouse Household ExpensesFood & Entertainment Your Spouse Food & EntertainmentOther Monthly Expenses Your Spouse Other Monthly ExpensesPreviousNextCONSENTS AND DECLARATIONS *I hereby give consent to Xaviers Auto to submit my application to relevant finance providersConsent to Access Credit Information : I hereby authorise the credit provider or its agents to make enquiries about my credit record with any registered credit bureau. I consent to the disclosure of my credit information to the necessary parties to process this application.I consent to the Finance and Insurance Consultant obtaining insurance quotes.I give consent for my documents to be used for licensing and registration of the vehicle.I consent to my data being retained for future marketing purposes.I declare the information provided is true and correct.Signature * Clear Signature Date / Time *Submit Facebook-f Whatsapp Envelope Mon-Fri: 08:00-17:00Sat:08:00-13:00Sun:Closed Home About Us Gallery Finance Form Sell Your Car Contact Us Home About Us Gallery Finance Form Sell Your Car Contact Us © 2025 Created by Inwebdesign