APPLICATION BY CONSUMER FOR DEBT REVIEW
In terms of section 86 of the National Credit Act 34 of 2005
(FORM 16)
Please note that:
1. On receipt of this application the debt counsellor will advise all credit providers and all registered credit
bureaus that you have applied for debt review;
2. You will be listed with all registered credit bureaus that you have applied for debt review;
3. This form must be accompanied by a list of all credit providers as well as copies of all documents requested;
4. Should any documents not be submitted within 10 days of the Application being received by the Debt
Counsellor, your application will not be accepted.
Marital Status & Dependants
Dependents Information
Dependents Information
Dependents Information
Dependents Information
Dependents Information
Dependents Information
Dependents Information
Part 5 - Declaration by the Consumer
I declare as follows:
1. I undertake to comply with all requests from the debt counsellor to assist him/her to evaluate my state of indebtedness and the prospects for responsible debt restructuring;
2. I hereby consent to the submission of my information to all registered credit bureaus by the debt counsellor;
3. I also consent that the debt counsellor may obtain my credit record from any/all registered credit bureaus and any other registers which may contain any of my credit information;
4. I undertake not to enter into any further credit agreements, other than a consolidated agreement, with any credit provider until one of the following events has occurred:
a the debt counsellor rejects my application
b the court determines that I am not over-indebted; or
c all my obligations under credit agreements as re-arranged are fulfilled
5. I confirm that the information contained in this document is, to the best of my knowledge, true and correct.
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NB: IN ORDER FOR YOUR DEBT REVIEW APPLICATION FORM TO BE PROCESSED THERE IS A R50.00 FEE PAYABLE BY USING THE PAY NOW BUTTON BELOW. ONCE YOU TRANSACTION HAS BEEN COMPLETED YOU APPLICATION FORM WILL BE SUBMITTED FOR PROCESSING.
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