1 Step 1

Part 1 - Personal Details

Spouse Details (Compulsory if married in COP or African Traditional)


Not Applicable

Part 2 - INCOME


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

Deductions


[ field57 - field78 ]



[ field80 - field56 ]


Part 3 – MONTHLY COMMITMENTS


(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 by attaching it with the application form





PART 5 - DECLARATION


1. l/We undertake to comply with all requests to assist him/her to draft the application and the prospects for responsible to clearing my credit record.

2. l/We also consent that the company may obtain and submit my/our credit record from any/all registered credit bureaus and any other registers which may contain any of my/our credit information.

3. l/We confirm that the information obtained in this document is, to the best of my/our knowledge, true and correct.

4. l/We the undersigned consumer/s hereby agree and undertake to keep the Company indemnified against all loss or damage from any cause arising which l/we may sustain as a result of the application in terms of rule 49 of the Magistrates Court Rules of Court.

5. An application fee of R6000.00 (inclusive), in respect of this application.


Part 7 – Reason for Over Indebtedness


Declaration


I hereby declare that the information supplied by myself in the application form is for myself and is true and correct, and includes all my credit agreements. I consent to Debt Rescue obtaining my credit report from a registered credit bureau for the purpose of obtaining my credit agreements to assist in the assessment.*

This application for quotation must be accompanied by the following documents

keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right