Leasing Application - Car Leasing in the Netherlands

1. Applicant Details

Date of application *

Personal Details

Full name *

Date of birth *

Registered Address

Street name and number *

Postcode and city *

Country * Please note: if you are registered in the Netherlands, please provide your Dutch address.

Enter the country name *

Contact Details

Phone number *

Email address *

Bank Details

Account number for direct debit (IBAN) * The lease payments will be collected from this account (business or private).

Account holder (full name) *

2. Financial Details

Do you plan to make a down payment? *

Yes, specify the amount in euros

No

Enter the down payment amount in euros *

Net value of the leased asset (amount) *

Purpose of the lease (optional)

Are you registered with the BKR? *

No, I have no debt registered with the BKR

Yes, I have debt registered with the BKR

3. Type of Lease

Type of vehicle *

Passenger car

Commercial vehicle (van)

Private or business lease? *

Private lease

Business lease

Lease type *

Financial lease

Operational lease

With an operational lease, the asset remains the property of the lessor, who pays the insurance, road tax and servicing. With a financial lease, the asset is a fixed asset of the lessee, who bears all the costs.

4. Vehicle Details

Registration number (if applicable)

Brand

Model

Year of manufacture

Mileage

5. Term and Timing

What lease term would you like? *

When would you like the lease to start? *

Final instalment amount (Slottermijn) *

Yes, specify the amount in euros

No

Enter the final instalment amount in euros *

6. Documents and Consent

Assistance from the MOJKA office with the car insurance application *

No, I will arrange the car insurance myself

Yes, please submit an insurance application on my behalf

Additional information relevant to the lease (optional)

Click to add documents *

(max. 10 files at a time)

Please note: required documents — proof of identity and proof of income. Only PDF and JPG files are accepted (max. 2 MB).

I declare that all information provided in this form is current and truthful. MOJKA Finance accepts no liability for any discrepancy in the data. I also confirm that I have read and fully accept the General Terms and Conditions.

Signature (full name) *