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APPLICATION FORM

APPLICATION BY CONSUMER FOR DEBT REVIEW

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


Please note that:
1. On receipt of this application the debt counselor 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 Counselor, your application will not be accepted.


PERSONAL INFORMATION



INCOME / EXPENSES