DEBT REVIEW APPLICATION FORM

CONSUMER: NAME & SURNAME

RSA ID NUMBER

Where did you hear about Janice Croft Attorneys & Debt Counselors?

WORD OF MOUTH
INTERNET
FACEBOOK
HERALD
FLYER
BROACHER

ACCREDITED WITH THE NATIONAL CREDIT REGULATOR

(NCR 1790)

APPLICATION FOR DEBT REVIEW

In terms of Section 86 of the national Credit Act 34 of 2005

  • No incomplete application can be attended to. Please complete ALL sections in detail and provide all the documentation required.
  • Consultation fee: R50.00.
  • Credit Bureau Fees – R100.00 per person (if provided by consumer, this fee is not application).
  • The consultation and/or credit bureau fees are payable cash or included as a once off payment on the repayment plan.
  • Any fees will form part of the repayment plan and according to the prescribed NCR fee structure.
  • PLEASE INITIAL EVERY PAGE.

All the documents as requested in the DEBT REVIEW PROCESS must be attached in order for the debt review process to take effect.

PLEASE NOTE THAT:

  1. On receipt of this application, the Debt Advisor will advise all credit providers and all registered credit bureaus that you have applied for debt review,
  2. Should any outstanding documents not be submitted within 3 days of the Application being received by the Debt Advisor, your application can unfortunately not be accepted;
  3. If married in community of property (COB), both parties must apply for debt review according to the National Credit Act;
  4. Please note! Credit cards or cheque accounts might be frozen by the banks or money grabbing can be done on money (salaries) paid into accounts in arrears, including savings accounts. To avoid this, open an account at a bank where you have no debt obligation;
  5. Arrange with your Employer for your salary to be paid into the new account;
  6. Stop all debit orders going off these account(s)- at the Bank(s) and also at credit providers, doing this in writing;
  7. Arrange for new debit orders on living expenses, e.g. for insurance, medical aid etc. refer to point 4 above;
  8. Please note! Should you make no monthly payments to the …………………………. Who will pay your credit providers, the credit providers will proceed with legal action against you, which can result in you losing your assets;
  9. You are not allowed to take a payment holiday during your debt review process.

PLEASE ENSURE THAT YOU RECEIVED A BROUCHER EXPLAINING THE DEBT REVIEW PROCESS BY YOUR DEBT ADVISOR AND THAT YOU UNDERSTAND THE PROCESS IN FULL AND THAT YOU READ AND UNDERSTAND THE DECLARATION BEFORE SIGNING

Please complete this form in print

APPLICATION BY CONSUMER FOR DEBT REVIEW

In terms of Section 86 of the National Credit Act, Act 34 of 2005

PART 1: PERSONAL DETAILS
Surname : / Full name:
Known as:
ID Number:
Male / Female / White / African / Coloured
Marital Status: / Single / COP / ANC / Other
Physical Address: / Number:
Suburb: / Town: / Postal Code:
Postal Address: / City / Postal Code:
Tenant: / Owner:
Contact Details: / H/W / Cell:
Fax: / Email:
DEPENDANTS
Full names / Date of Birth / Relationship / Live with you?
1.
2.
3.
4.
5.
EMPLOYMENT
Current Employer: / Occupation:
How long at employer: / Monthly payment date:
Yearly increase date: / 13thcheques/Bonus date:
SPOUSE/PARTNER
Surname: / Full names:
ID Number:
Male / Female / White / African / Coloured
Physical Address: / Number:
Suburb: / Town: / Postal Code:
Postal Address: / City / Postal Code:
Tenant: / Owner:
Contact Details: / H/W / Cell:
Fax: / Email:
EMPLOYMENT
Current Employer: / Occupation:
How long at employer: / Monthly payment date:
Where did you hear about Janice Croft Attorneys & Debt Counselors

I, …………………………………………………………………………. Confirm that I have applied for Debt Review under Section 86 of the national Credit Act 34 of 2005 on ………………………………………………………… I further confirm that all information with regard to my financial obligation contained in this application is true and correct.

Signature: ………………………………………......

PART 2 – BUDGET
MONTHLY BUDGET / CONSUMER

Notes:

Please describe other

If you pay annually please divide by 12

INCOME: / SELF / PARTNER
TOTAL GROSS INCOME
Investment income
Other income (e.g. overtime)
Rental income
Total Income
PAYSLIP DEDUCTION
PAYE (TAX)
SITE
UIF
Pension Fund
Medical Aid
Garnishee/Admin Order
Group Life
Insurance
RA’S/Endowment
Other
TOTAL NETT SALARY
LESS LIVING EXPENSES
CHILDREN
After Care
Boarding Fees
Child’s transport
Crèche
Pocket money
School fees
University/Tech Fees
GROCERIES
Bread & Milk
Fruit & Vegetable
Meat
HEALTH
Doctors
Medical expenses
Chemist
HOME
Body corporate levies
Cleaning equipment
Domestic worker
Dry clean
Entertaining at home
Gardener/Garden service
Gas
Home Maintenance
Internet
Landline (Telkom)
Pool chemicals
Rates & Taxes
Rent/Boarding & Lodging
Security
TV License
Water & Electricity
Insurance & Financial
Bank charges
Life insurance
Other financial services
Short term insurance
Relaxation Entertainment
Cigarettes & Liquor
DSTV
Hobbies
Membership
Movies
Other entertainment
Social Clubs
Sports
Transport
Taxi/Train fare
Car License
Car Maintenance
Fuel
OTHER
Clothing
TOTAL LIVING EXP
SHORTFALL
MONEY LEFT TO PAY OFF DEBTS

PROVIDE REASONS WHY YOU ARE OVER-INDEBTED COMPULSARY

………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….……………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………….

PART 3 - DEBT OBLIGATION

ALL CREDIT PROVIDERS (LOANS, CREDIT CARDS) THIS MUST BE COMPLETED IN FULL IN ORDER TO OBTAIN IFNORMATION

NAME OF CREDIT PROVIDERS / ACCOUNT NUMBERS/REF / OUTSTANDING AMOUNT / INITIAL INSTALLMENT / PROPOSED INSTALMENT

I, THE UNDERSIGNED, DECARE AS FOLLOWS

  1. I understand to comply with all requests from Debt Advisor 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 Advisor;
  3. I also consent that the Debt Advisor may obtain my credit records 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 consolidation agreement, with any credit provider until one of the following events has occurred:
  • The Debt Advisor rejects my application;
  • The court determines that I am not over-indebted; or
  • All my obligations under credit agreements as re-arranged are fulfilled.
  1. The Debt Review process was explained to me and I have read and understand the Debt Review Process;
  2. Debt Review Fees and legal Fees applicable are as set out in the Fee Guidelines, Part 6. I understand and accept these fees. I shall accept any additional fees only when advised in writing;
  3. I understand that I MUST NOT SIGN ANY DOCUMENTS whatsoever which I receive from any credit provider and shall make no promised, either verbally or in writing, to any credit provider and understand that ANY payment to a credit provider will be done through PDA by arrangement with the Debt Advisor;
  4. If I lodge a complaint of reckless lending, I confirm that the information I gave to the credit provider on the application for credit was true and correct;
  5. If I have any additional money that I want to pay towards my debt, I will arrange with the Debt Advisor for the payment to be made through the PDA, so records and interests rates can be adjusted by them;
  6. I confirm that the information contained in this document is, to the best of my knowledge, true and correct.
  7. I indemnify all employees and nominees of Janice Croft Attorneys and Debt Counselors against any claim that may be instituted against it or them arising from any act or omission by such person appointed by Janice Croft Attorneys and Debt Counselors or its nominee in the lawful execution of the terms and conditions of this Agreement/Power Of Attorney entered into with myself, and confirm that Janice Croft Attorneys and Debt Counselors shall not be liable for any damages suffered by me resulting from the act or omission of whatsoever nature, however arising.
  8. I hereby acknowledge that all lawful actions taken by Janice Croft Attorneys and Debt Counselors under its power this Power of Attorney are tacitly ratified by me, and I will be bound by such arrangement as principal debtor.

SIGNED at …………………………………….. ON THIS DAY ……………. OF ……………………………………………… 20…….

APPLICANT: …………………………………………………… SPOUSE/PARTNER: ………………………………………………….

PART 6 – DEBT REVIEW FEE STRUCTURE

DEBT REVIEW FEE STRUCTURE

The Debt Advisor may receive the following amounts in respects of consumers with an individual gross income of more than R2 500.00 per month or a household income of more than R3 000.00 per month.

  1. An Application Fee, recoverable directly from the Consumer upon receiving an application for Debt Review, limited to the amount prescribed in terms of Schedule 2(2) of the NCA i.e. R50.00.
  2. A rejection fee of R300.00 (excl VAT) in respect of Consumer whose application have been rejected in terms of Section 86(7)(a) of the NCA.
  3. A restructuring fee of the lesser of the first installment of the debt rearrangement plan or R3 000.00 (excl VAT), in respect of a Consumer whose application has been accepted in terms of Section 86(7)(b) or Section 86(7(c). Should a joint application be required, the fee is increased to R4 000.00 (excl VAT). This fee will be included in the restructuring process.
  4. A monthly aftercare fee of 5% (excl VAT) of the monthly installment of the Debt Rearrangement Plan. This fee will be included in the restructuring process.
  5. Should the Consumer withdraw from the process after paying the restructuring fee, a fee equal to 75% of the restructuring fee is payable by the Consumer.
  6. In order to obtain a consent order, and attorney must be appointed. The legal fees will amount to R2 500.00 (excl VAT) and is payable by the Consumer. The legal fees will be deducted from the consumer’s Debt Review Contribution during the second month of debt review. Kindly note that the legal fees are subject to change, but any change to the fee wil be communicated to the consumer in writing.

Kindly note that failure to make provision for monthly payments will result in your application being terminated in terms of Section 86(10 of the National Credit Act and you will not be protected against legal action from your credit providers.

SIGNED at ………………………………………. ON THIS DAY ………. OF ………………………………………. 20……

CONSUMERS: ………………………………………… DEBT ADVISOR/CONSULTANT ……………………………….

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