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Personal Information

To ensure the security of your personal information
please complete the following:

Personal Info1


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If you are married:

- in community of property OR by Customary Law (prior to 15/11/2000)

then you are required to obtain, in terms of the Matrimonial Property Act, consent from your spouse to enter into any credit agreement.

If so, please confirm that you have your spouse's permission to enter this agreement.


Contact & Address2


Physical address


I would like to receive information on exclusive offers and deals via Email.

I would like to receive information on exclusive offers and deals via SMS.

I would like to receive information on exclusive offers and deals via Phone.

May we disclose your details to other parties to correspond with you regarding other products that may be of interest to you?



Statement Delivery

Please note: your statement will be sent to you via e-mail or SMS if you have provided us with your details. Should you wish to change this, please contact our customer services department.

Employment & References3


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Banking & Financial Details4

Banking Details

In order to avoid paying unnecessary return debit order charges (levied by your bank), it is advisable to make the debit order effective date as soon as possible after you receive your salary.

I have read, understood and accept the terms and conditions of this Debit Order instruction form.


Would you like to be considered for regular, automatic credit limit increases?

Income & Expenses5

Monthly Income

Rent Bond

Terms & Conditions6

Customer Protection Insurance

For your protection, your Card may include our optional Customer Protection Insurance.

The RCS Customer Protection Insurance (underwritten by Guardrisk Insurance Company Limited) provides the following cover:

• Death and Permanent Disability Cover (covers your full outstanding balance);
• Temporary Disability Cover (covers up to 12 months instalments);
• Loss of Income Cover (covers up to 12 months instalments)

The premium is charged at a monthly rate of R4.04 per R1, 000 outstanding balance. It is important to note that all pre-existing conditions are excluded for the first 12 months of cover and that loss of income cover is only applicable after a 3 month waiting period.

You have the right to waive the proposed RCS customer protection Insurance policy with Guardrisk and substitute it with a policy of your own choice, which covers the same benefits. This may be ceded to RCS with written documents as stipulated in the National Credit Act 34 of 2005

You will need to accept the following terms and conditions in order to start the account application process.


I understand and accept the terms and conditions

Please accept the Terms and Conditions

Thank You


Your reference number is 6546546

Upload Your Income Verification Files

ID Document

Bank Statements