Copy and Paste the application form and complete it with figures off your latest creditor’s statements.  List all debt in the application form and send it to the following address: didibasson@yahoo.com or fax it to 086 541 4246  You will then be contacted by a Debt Counsellor.

If you need more information, please contact  -

Wynand Basson - 082  447 8313

Didi Basson - 083 618 3748

Application By Consumer For Debt Review

In terms of section 86 of the National Credit Act 34 of 2005

 

Applicant Details:

	1stapplicant	2nd applicant
1.Title
2.First names
3.Surname
4.Maiden name
5.Birth date
6.ID no (Attach a copy of ID)
7.Passport no
8.Gender
9.Race
10.Marital status
11.Date (separated/divorced)
12.If Married (C.O.P or A.N.C)
13.Residential address
14.Postal code
15.Postal address
16.Postal code
17.Property Ownership
18.Period at address
19.Number of dependants
20.Email
21.Home telephone
22.Work telephone
23.Cellular

 

Employment Details:

	1stapplicant	2nd applicant
1.Occupation
2.Employer:
3.Employer’s street address
4.Postal code
5.Period employed
6.Employer telephone number
7.Employer fax number
8.Employer email

 

Bank Details:

	1stapplicant	2nd applicant
1.Bank name
2.Branch name
3.Account name
4.Account no
5.Branch code
6.Account type

 

Income: e.g. Maintenance, rent received, second job etc.

	1stapplicant	2nd applicant
Gross salary
Cell phone Allowance
Car Allowance
Housing allowance
Additional Company Income
Bonus (yearly Monthly)
Bonus (Other specify)
Pension (specify)
Commissions*
Other (specify)
Other (specify)
TOTAL

 

*If irregular commission or overtime work on 6 month average

*If seasonal income work on 12 months average

Expenses:

	1stapplicant	2ndapplicant	Dependants
Bond Repayments / Rent
Rates and Taxes
School Fees
Vehicle/s
Bank Charges
Cell phone/s
Clothing (include school and sport, etc.)
Electricity
Household groceries
Life insurance
Medical aid
Petrol
Public Transport
Security
Telephone
Other (specify)
Other (specify)
TOTAL

 

Debt Obligations/Creditors (Loans, Credit cards, store accounts etc.)

  

	Credit Provider	Debt Amount	Monthly payment	Total Arrears	Account Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

I/We .................................................................................. declare as follows:

 

1. I/We declare to comply with all requests from Basson’s Debt Counsellors to assist him/her to evaluate my state of Indebtedness and the prospects for responsible debt restructuring.

2. I/We hereby consent to the submission of my information to all registered credit bureaus by Basson’s Debt Counsellors.

3. I/We also consent that Basson’s Debt Counsellors 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/We 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:

·                     Basson’s Debt Counsellors rejects my application;

·                     The court determines that I am not over-indebted; or

·                     All my obligations under credit agreements as rearranged are fulfilled.

5. The debt counselling process was explained to me, in short I declare that I understand that:

·         Basson’s Debt Counsellors will inform my creditors of my application, after receiving my COMPLETE  application.

·         Basson’s Debt Counsellors will evaluate if I am over-indebted or not and inform creditors as such.

·         The Creditors will freeze interest on accounts for 60 days, in which time Basson’s Debt Counsellors must try to negotiate an informal rearrangement of debt with creditors. Only Interest is frozen and not payments.

·         If an informal settlement could not be reached, Basson’s Debt Counsellors will apply through court application.

·         I understand that I will be responsible for any legal costs, accepted beforehand in writing by me.

·         Basson’s Debt Counsellors will draw up an interim proposal to creditors and I will start paying the proposed amount immediately, when requested by Basson’s Debt Counsellors, until a final consent order was accepted by both parties.

·         The first proposed payment will go to Basson’s Debt Counsellors for services rendered and fees are applicable, as set out in the “Fees Guideline – 2008”, which I have read and understand.

·         I will inform Basson’s Debt Counsellors of any changes of address, work, increases and bonuses.

·         I will arrange for a debit order to be deducted from my bank account or a garnishee order from my salary, for monthly deductions by the NCR approved PDA (Payment Distribution Agency), who will distribute the monthly payments to my creditors.

·         After fulfilment of my obligations, the Debt Counsellors will issue a Clearance Certificate to all Credit Bureaus and my name will be cleared at all Credit Bureaus.

6. I understand that I must sign no documentation I receive from any Creditor and shall make no promises verbally or in writing to any Creditor.

7. If I lodge a complaint of reckless lending, I will be sure that the information I gave to the Creditor was true and correct.

8. If I have any additional money that I want to pay towards my debt, I will arrange with Basson’s Debt Counsellors for

the payment to be made through the PDA, so records and interest can be adjusted by them.

9. I confirm that the information contained in this document is, to the best of my knowledge, true and correct and that this is the only income I receive.

 

Signed at _______________________________ on the _____________ dayof________________________2009

 

 

Full Name: ______________________________________ ID/Passport No. ______________________

 

 

Signature: ______________________________________

 

 

Spouse’s Full Name: _______________________________ Signature: __________________________