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Membership Application


 
 
MEMBERSHIP APPLICATION
Complete the application form and submit electronically or download the membership application form and fax to 012 663 2383.
 
A
 DEALERSHIP DETAIL  
     
1. Registered name of Dealership:
2. Trading Name:
3.
Registration number:
VAT No
4. Date business commenced / Letter of Authority:

5.

 Please indicate if Manufacturer Franchise:
YES NO (Tick applicable box)
6. Independent / Group dealer:
     
7. Dealership Shareholding:  
 
7.1 Name
  Surname
  ID Number:
  Telephone:
  Fax number:
  Cell number:
  E-Mail:

     
 
7.2 Name
  Surname
  ID Number:
  Telephone:
  Fax number:
  Cell number:
  E-Mail:
     
 
7.3 Name
  Surname
  ID Number:
  Telephone:
  Fax number:
  Cell number:
  E-Mail:
     
8. Dealer contact person:  
 
Name:
Surname:
ID Number:
Position:
Telephone number:
Fax number:
Cell number:
E-Mail:
     
9. Physical address:  
   
   
   Postal Code: 
     
10. 
Province:
 
     
11.  Postal address:  
   
   
   Postal Code: 
     
12.  Independent F&I:
YES NO (Tick applicable box)
  Bank F&I:
YES NO (Tick applicable box)
   
         
13.  If "YES"  
 
  Name:
  Surname:
  ID number:
  Position:
  Telephone number:
  Fax number:
  Cell number:
  E-Mail:
  Number of years F&I experience:
  Number of current credits:
  Additional FSP product courses:
  Institution:
  Course:
  Date completed:
  Value Added Product courses:
  Institution:
  Course:
  Date completed:
   
14.  FAIS accredited
YES NO Busy with accreditation
  If "NO"  
 
a. Would you require the services and assistance of an independent Roving F&I – AT NO ADDITIONAL COSTS to the dealership?
YES NO
     
15.  Number of units sold per month:
1. Cash:
   
2. Financed:
   
3. Pre-approved:
     
16.  Stock:
Oldest year model:
   
Average year model:
   
Newest year model:
17.  Which electronic system are you currently using?
Dealernet Signio I-Quote
Sereti Other: 
 
B
 FINANCIAL SERVICES PROVIDER LICENSE  
     
1. Current FSP License number:
2. Agent / Own license:
  If applicable name of agent:
 
3. Full names and surname of FSP Representative:
 
 
4. Registration / ID number:
     
5. Country of registration if juristic person:
6. Physical Address:  
   
   
   Postal Code: 
     
7. Full names and surname of Key Individual of representative:  
   
     
8. ID number of Key individual:
9. Number of months experience:
10. Educational qualifications:
11. Number of credits required by 31 December 2009:
12. Number of current credits:
13. Do you have any pending compliance complaints / cases:
YES NO (Tick applicable box)
  If yes, provide full details to the pending case(s):  
 
 
C
 DEALER SUPPLIER APPROVED DETAILS  
     
  FINANCE  
  NAME OF FINANCIAL INSTITUTION: Code:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
     
  VALUE ADDED PRODUCTS (VAPS)  
  Supplier:
Products: Code:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
     
     
  FULL NAMES AND SURNAME OF APPLICANT:
  DULY AUTHORISED IN HIS / HER CAPACITY AS:
  DATE OF APPLICATION:
     
DECALRATION
The Applicant hereby declares that:
i. All the particulars stated above are both true and correct;
ii. He / she has not withheld any material facts or information;
iii. He / she agrees that this proposal and declaration shall form the basis of the contractual agreement between the Applicant and DNA;
iv. All activities and financial transactions, conducted will be performed in accordance with the requirements of the Financial Services Board and applicable legislation, i.e. FAIS, FICA and the NCA;
v. He / she shall at all times perform all functions of an representative / intermediary with specific reference to the requirements of Fit and Proper Conduct as determined in FAIS and shall give effect to all requests and/or instructions given to it by DNA in accordance with this agreement;
vi. He / she is not aware of any acts performed or omissions at the dealership, in contradiction or violation in respect of governing legislation and with specific reference to (iv) and (v) above;
vii. In the event that any of the above information is incorrect, false or incomplete, DNA will summarily terminate any and all agreements between the Applicant and DNA without notice and recourse by the Applicant;
viii. He /she indemnifies DNA against all actions, claims, damages (including consequential damages) or any other liability which the Applicant or any third party may sustain either directly or indirectly arising out of any intentional or negligent act or omission by DNA, or its employees or agents acting in the course and scope of their employment or mandate with DNA, and any act of omission of the employee or agent of the Applicant, and this indemnity will extend to any rulings made by the FAIS Ombudsman in respect of the FSP License;
ix. He/ she will ensure that the dealership utilizes only the systems as approved on DNA’s panel and that all financial activities will be performed via the nominated electronic system;
x.
 He/ she will perform all services as per this application with due care, integrity, honesty and diligence;
   

 
 

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