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, and you will not be able to obtain any further credit.
  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.
  5. All Payments need to be made directly to the PDA trust account. The Debt Counselor will provide you with the banking details of the PDA – DC Partner
  6. A consumer cannot withdraw from the Debt Counselling process after the Form 16 (application form) has been signed. The debt counsellor can only reject the application should it be found that the consumer is NOT over-indebted. Proof thereof will have to be submitted to the NCR in order to clear the debt counselling listing from the consumers credit profile.
1 Step 1

Form 16

Part 1 - Personal Information


Part 2 - Income Please Note If You Attach The Payslip (It”s Compulsory) You Can Leave Out This Section Of The Application


Not Applicable

Part 3 - Monthly Commitments Household Expenses


Please list all monthly commitments other than outstanding debt, i.e. school fees, travelling costs, medical expenses, etc.

Part 4 – Debt Obligations (Please Provide Copies of All Outstanding balances due, even if It is old)


 

 

 

 

 

 

 

 

 

 

 

 

Part 5 – DEBT COUNSELLING FEES DISCLOSURE

The Debt Counsellor may receive the following amounts in respect of consumers who have applied for debt counselling:


I/We declare as follows:

1. I/We 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. I/We also consent that the debt counsellor may obtain my/our credit record from any/all registered credit bureaus and any other registers which may contain any of my/our credit information.
3. The debt counsellor rejects my/our application

By selecting "Agree" and submitting this form, you acknowledge and agree that this action constitutes your digital signature. This electronic agreement is legally binding and has the same effect as a handwritten signature.
reCaptcha v3
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right