Debt Review Application Brakpan

By completing this form, you are providing Debt Merge with the above personal information and acknowledge the terms of Debt Merge’s Privacy Notice

The National Credit Act formally introduced Debt Counselling to assist over-indebted consumers like yourself by developing a repayment plan, which is affordable to you as well as acceptable to all your Credit Providers.

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FORM 16

Application for Debt Review by the Consumer i.t.o Section 86 of the National Credit Act 34 of 2005
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PART 1A - PERSONAL INFORMATION

Name
Gender
Marital Status:
Address
Property ownership:
Relative Name:

PART 2A

Documents Attached:
Max. file size: 32 MB.

PART 3 A: BUDGET

LIVING EXPENSES:

PART 4: MONTHLY OBLIGATIONS

1

2

3

4

5

6

7

8

9

10
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Max. file size: 32 MB.
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PART 5: DEBT REVIEW FINDINGS

Have you been registered under debt review before
Reason for new application with our offices:

PART 6: OVER-INDEBTEDNESS

FACTORS CONTRIBUTING TO OVER-INDEBTEDNESS

PART 7: DECLARATION BY THE CONSUMER/S

  1. 1. I undertake to comply with all requests from the Debt Counsellor to assist him/her to evaluate my/our state of indebtedness and the prospects for responsible debt restructuring;
  2. 2. I/We hereby consent to the submission of my/our information to all Registered Credit Bureaus by the Debt Counsellor; I/we further confirm I/we have read the contents of Affirmative Debt’s commitment to the POPI Act and accept herewith and willingly give permission for Affirmative Debt to use my/our personal information – as provided by my/ourselves – for the debt review process and all debt review related parties involved, for such proceedings to each and improve my/our financial position until a Clearance certificate is issued and my/our file is closed.
  3. 3. I/We also consent that the Debt Counsellor may obtain my/our credit record from any/all Registered Credit Bureaus and debt review related parties and any other registers/entities which may contain any of my/our information;
  4. 4. I/We confirm that the information contained in this document/s is, to the best of my/our knowledge, true and correct.
  5. 5. I/We also understand that should I/we skip payments, I/we will still be liable for the monthly DC fee towards my debt counsellor, which will be payable within 30 days.
  6. 6. I/We will ensure that my/our monthly commitments will be kept up to date and I/ we will not enter into any further credit agreements, other than a consolidated agreement, with any Credit Provider until one of the following events have 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 agreement as re-arranged are fulfilled;
  7. 7. I/We also confirm that I/we shall keep to the arranged Distribution amount as indicated on the budget and/or agreed to after the proposal was issued, even if the Debt Counsellor changes our budget from time to time according to regulations.
  8. 8. I/We acknowledge that creditors may terminate on short or late payments and that I/we take full responsibility and cannot keep my/our Debt Counsellor accountable for this type of termination.
  9. 9. I/We will inform the Debt Counsellor of any changes whatsoever.
  10. 10. I confirm that my debt counsellor has advised me/us that I/we may select any attorney to represent my/our debt review application in court and that she will willingly give my documents to my/our appointed attorney to support him/her in my/our application.
  11. 11. I/We further more declare that I/We have no other financial obligations or income that is not disclosed in the documents forming part of this application and particularly in the Form 16 (Debt Review application Form).
DD slash MM slash YYYY
Consumer / Applicant
Max. file size: 32 MB.
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