Please follow instruction and sign this page also. Make sure to post the original copy to P.O.Box 569, Vereeniging.

Transcription

1 To whom it may concern Please follow instruction and sign this page also. Make sure to post the original copy to P.O.Box 569, Vereeniging. Complete all pages, except page 6 and 7. Keep pages with CLIENT COPY on top and use this page to cancel debit orders on your account and to place your stop order with the amount worked out for you by our consultant. You may need to write a letter with this page 1, and send it to your banks head office, to cancel the debit orders. NB: If pages look out of space, please click Page Layout on toolbar and select Margins and then select Narrow. If joined application, partner must sign own Power of Attorney and the page starting DATED and SIGNED. Thus, meaning there will be 2 Power of Attorney pages and 2 pages starting DATED and SIGNED. The page DATED and Signed is for your court application. Please fax application to and Post the original, using normal post to; P.O.Box 569 Vereeniging 1930 Thanks Any questions, please contact one of our offices or Customer Care Head Office - Vereeniging / Johannesburg / Pretoria / Port Elizabeth / Bloemfontein / Bethlehem Durban / Thanks Clients : NB!! Please send Id copy, 3 months bank statement, Salary advise and list of all credito

2 CLIENT COPY Reg nr: 2012/059696/07 To whom it may concern: RE: REQUEST TO PLACE STOP ORDER ON ACCOUNT Please assist our client below to place a STOP ORDER on his/her account towards his/her Debt Review Payment. Client name: Client Id Number: Ref: CLIENTS FULL ID NUMBER The client s monthly instalment: R 1 st Instalment due: _/ _/20. Account Details: Account name: NPDA Trust Account Bank: Nedbank Account Nr: Branch Code: Please assist the client by giving him/her a copy of the STOP ORDER to be faxed or handed in at K2DF. Your co-operation will be highly appreciated. For any queries please phone / Fax nr: Kind Regards LC Hattingh DEBT COUNSELLOR NCRDC 1978 / 2237

3 CLIENT COPY Page 1 Date: TO WHOM IT MAY CONCERN CLIENTS PARTICULARS: Surname: Full Names: ID: CONFIRMATION OF DEBT REVIEW I, the registered Debt Counsellor, registration number NCRDC 1978 / 2237 hereby declare that the consumer as stated above applied for debt review (Sec. 86 of the National Credit Act) at our offices.the Debt Counsellor will be responsible for the final assessment and restructuring of all agreements with the creditors. The contact details for all enquiries are as follows: Phone number : Fax no : kobie.hat@telkomsa.net Always use ID as reference Please do not hesitate to contact us for any further information. The abovementioned client requests that debit orders, relating to his/her bank account nr, Must be stopped immediately to give legislated effect to the Debt Review process. Send this information to your head office Debt Review Department to stop all debit orders on clients account. Reference is given to the following point in support of this request: Bulletin Number 12 as issued by the Ombudsman for Banking Services, 31 May 2006 The customer s rights A customer can give their bank a written stop payment instruction to prevent a debit order for a specific amount being processed on the account. When a debit order is returned payment Stopped on the instruction of a consumer, the user may not process further debits under the system. Should I the undersigned terminate the debt review application process for what so ever reason, I will remain responsible and liable for the debt councillor s fees up to the point of such termination. In the event of my non payment of such fees I understand that legal steps may be instituted against myself for the collection of such fees. Signed at on this day of 20. Client: (signature) Yours faithfully L C Hattingh NCRDC 1978 / 2237

4 No CASH ever to be paid at any office or to any consultant. Monthly instalments to be paid to NPDA trust account.

5 OFFICE USE Page 1 Date: TO WHOM IT MAY CONCERN CLIENTS PARTICULARS: Surname: Full Names: ID: CONFIRMATION OF DEBT REVIEW I, the registered Debt Counsellor, registration number NCRDC 1978 / 2237 hereby declare that the consumer as stated above applied for debt review (Sec. 86 of the National Credit Act) at our offices.the Debt Counsellor will be responsible for the final assessment and restructuring of all agreements with the creditors. The contact details for all enquiries are as follows: Phone number : Fax no : kobie.hat@telkomsa.net Always use ID as reference Please do not hesitate to contact us for any further information. The abovementioned client requests that debit orders, relating to his/her bank account nr, Must be stopped immediately to give legislated effect to the Debt Review process. Send this information to your Head Office Debt Review Department to stop all debit orders on clients account. Reference is given to the following point in support of this request: Bulletin Number 12 as issued by the Ombudsman for Banking Services, 31 May 2006 The customer s rights A customer can give their bank a written stop payment instruction to prevent a debit order for a specific amount being processed on the account. When a debit order is returned payment Stopped on the instruction of a consumer, the user may not process further debits under the system. Should I the undersigned terminate the debt review application process for what so ever reason, I will remain responsible and liable for the debt councillor s fees up to the point of such termination. In the event of my non payment of such fees I understand that legal steps may be instituted against myself for the collection of such fees. Signed at on this day of 20. Client: (signature) Yours faithfully L C Hattingh NCRDC 1978 / 2237 No CASH ever to be paid at any office or to any consultant. Monthly instalments to be paid to NPDA trust account.

6 Page 2 DEBT REVIEW CONTRACT WITH KEY 2 DEBT FREEDOM (ANNEXURE A) FORM 16 In terms of Sec86 of the National Credit Act 34 of 2005, the documents as requested in THE DEBT REVIEW PROCESS must be attached in order for the Debt Review process to take effect. PERSONAL DETAILS Full name & Surname ID Number Race Gender Marital Status Single Married COP Divorced Traditional ANC Widowed Other No of Dependants Ages of Dependants M/F- M/F- M/F- M/F- Physical address District and Town/City Postal address Postal Code District and Town/City Postal Code Tel No (W) Tel No (H) Cell phone Number Name of Employer Work Address District Town/City Occupation Referred by Spouse / Partner s Information (Complete this section ONLY if this is a joint application for Debt Review) Full Name & Surname ID Number Tel No (W) Cell phone Number Name of Employer Work Address District Town/City Occupation Reason for application for Debt Review (Mark Applicable Block with X) Medical (Illness) Family Responsibility (Child Birth) Lifestyle (Excessive) Divorce Aggressive Marketing Accommodation (Rental) Accidents(Motor) Economic Factors (Interest rates) Retrenchment (loss of income) Substance Abuse (Alcohol, Gambling) Cost of Housing Death/Funeral Other: I hereby authorize Key 2 Debt Freedom to assist me with the following: 1 Credit Report Check 2 ID No Validation 3 References /other 4 Correspondence with employer if the needs arise when applicant is unable to assist with the necessary info. 5 Obtaining more affordable short term insurance quotations for improved affordability. Indemnity Declaration I hereby authorize Key 2 debt Freedom (PTY) Ltd and K2df Debt Counsellors (PTY) Ltd to verify my personal credentials and financial records. I furthermore unconditionally indemnify Key 2 Debt Freedom and its verification suppliers any liability that may result from furnishing information in this regard. Consent to service Hereby I/we (Name) consent to service of the Debt Review Application documentation and correspondence by /sms: Signed at on the day of. :

7 Page 3 Please fill out the following information for office use: 1. Confirm your marital status: 2. If married Traditionally please confirm the following: Registered Not Registered (Note that if you are Married Traditionally and the Marriage is registered this application must be completed by spouse as well and will follow Married in Community of property terms and conditions. Your spouse will also be added to the debt review process. Nb. provide proof of registration) 3. If Married out of Community of Property what is your spouse s employment status:? 4. If Married Out of Community of Property & your spouse is working what expenses does she cover: 5. If Married Out of Community of Property was any accounts listed entered into jointly If so which accounts: 6. Please fill out the following in full: (Please note that we need the following to ensure that when we proceed to obtain a court order the court will have all the information they require) Dependents Gender Age Relation to applicant ( if it is a daughter or son please state if they are your biological children) Receiving or paying maintenance? (If single/divorced) Receiving / Paying Amount Is Dependant Living with you? (Please state that if the Dependant is not our own child why you are the guardian) 5. Are you paying Water and Lights (if Not please state the reason) 6. Are you paying Education Fees (if Not Please state why) please provide name of the institution: Please note that above mentioned questions are there for us to be able to complete the Court application with the most updated and complete information as possible. Please note that it is your responsibility to ensure that all information you provide in this form are true and correct. Please also notify us of any changes in the above mentioned to ensure that we have the most updated information available, to ensure a correct Court Application. I confirm that the information given above are true and correct and I will notify the Debt counsellor of any changes in this regard. The debt counsellor will not take responsibility of any in correct information provided. Client signature:

8 Page 4 NCRDC: DEBT REVIEW CONTRACT WITH KEY 2 DEBT FREEDOM (PTY) LTD IN TERMS OF SECTION 86 OF THE NATIONAL CREDIT ACT 34 OF 2005 Client Name: Consultant Name: It is the responsibility of the consumer to ensure the information provided to the company is 100% factual and accurate. If at a later stage the information is found to be incorrect the consumer will be held liable, NOT the debt counsellor. It is also the consumer s responsibility to ensure NO further charges are incurred on any of the accounts under debt review and all cards are cut up. DEAR CLIENT-Please note, that this is not a LOAN and K2DF are NOT paying up all your debt. Only restructure it to lower instalments and lower interest rates. Contact debt counsellor if there are any changes in your lifestyle, income or on this application. FEE STRUCTURES AND PAYMENTS 1. Application Fee R Vat added to your instalment 2. Professional Debt Counselling Equal to the first instalment paid to Payment Distribution Agent, to a maximum of R VAT per Assessment Fee (Restructuring Fee) application.(included IN RESTRUCTURING PROCESS) 3. Aftercare 5% per month of monthly instalment paid to Payment Distribution Agent, to a maximum of R400+VAT for 24 months. 3% per month of monthly instalment paid to Payment Distribution Agent, to a maximum of R400+VAT for the remainder of the Debt Review term. 4. Termination Fee 75% of debt repayment instalment if proposal was done. 50% before proposals. 100% of debt repayment instalment, if court date is obtained. 5. Legal Fee for Consent Order R VAT (Excluding registered post and other expenses.) R80.00 per creditor for registered post and telephone calls. 6. Legal fee (Debt Review application to court) Minimum of R to maximum of R VAT (Excluding register post and telephone expenses) R80.00 per creditor for registered post and telephone calls. If consent order is obtained, the difference will be paid into NPDA account, for distribution to creditors. 7 Rejection Fee A rejection fee of R VAT will be payable, when the Debt Counsellor reject the application TASKS AND INFO 1 OPEN A NEW SAVINGS ACCOUNT- to prevent faulty debit order deductions, as Key 2 Debt Freedom will not be held responsible for any creditor debit orders. PLACE A STOP ORDER ON YOUR ACCOUNT, FOR THE DEBT REVIEW INSTALMENT. 2 If you are too late to arrange for your salary to be paid into your new account, please do the following: Instruct your bank to stop all debit-orders on your old account you may need to provide proof that you have applied for debt review (use the attached letter or phone head office for 17.1 form). Draw your full salary or transfer your full salary to your new account on your pay date. 3 If your application were done 10 business days prior to your remuneration date, you are required to make your first instalment from the 1 st month. If your application were done 9 or less business days to your remuneration date, you can start debt review instalments from the next remuneration date, BUT are required to pay your debt for that month yourself or follow Task and Info point 2. 4 All funds paid to your credit providers must be done through a registered PDA (Payment Distribution Agent) We use the National Payment Distribution Agency National Payment Distribution Agency will deduct your affordable distribution amount from your dedicated bank account by means of a debit order, Nu Pay system or a stop order. Please ensure that you sign the attached PDA mandate, allowing NPDA to collect the debit order and distribute to the relevant creditors. 5 You might be contacted by Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd, K2df Debt Counsellors (PTY) Ltd or the PDA from time to time, should we require additional information from you. 6 In case of default payments by myself to Key 2 Debt Freedom for professional service rendered I hereby consent to an Emoluments Attachment Order against my employer after the creditor, Key 2 Debt Freedom, has obtained judgement against myself for payment of monthly instalments until the outstanding amount, interest and legal fees has been paid in full. 7 I understand that I shall NOT be entitled to any refund from Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd or K2df Debt Counsellors (PTY) Ltd or NPDA. 8 Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd and K2df Debt Counsellors (PTY) Ltd will collect any outstanding fees via a debt collector and/or by means of Nu Pay System. CONSENT TO FEES *Hereby, I/We (Name) consent to the fees as stated above in fee structures and payments. I hereby acknowledge and understand that no fees or cash is to be paid at any office or account other than the NPDA trust account or Key 2 debt freedom (PTY) Ltd business account. ALWAYS ENSURE THAT THERE ARE SUFFICIENT FUNDS AVAILABLE IN YOUR ACCOUNT FOR THE DEBT REVIEW DEBIT/STOP ORDER, AND CONFIRM THAT THE DEBIT/STOP ORDER HAS GONE OFF. THE RESPONSIBILITY FOR PAYMENTS REMAINS YOUR OWN. KEY 2 DEBT FREEDOM (PTY) LTD WIIL NOT ACCEPT ANY RESPONSIBILITY FOR DEFAULT PAYMENTS. ANY OUTSTANDING FEES OWED BY THE CLIENT, WILL BE HANDED OVER FOR COLLECTION. I acknowledge that the consultant has explained the above to me, and that I understand and agree to adhere to the above. Full Name : : Date :

9 Page 5 DEBT COUNSELLING PROCESS 1 Application for debt review Key 2 Debt Freedom receives your application (Form 16) and required relevant information to determine whether you qualify for debt review. If you qualify, you are registered in the NCR database as being under debt review. At this stage R50-00 application fee is charged, as well as R50-00 per applicant for a credit check, if a credit report is not attached. 2 Preliminary assessment Of level of over-indebtedness and agreement on budget and monthly repayment amount towards debt. Debit order is signed for amount to de debited by PDA for distribution amongst creditors. Debit order applicable from first month of application, and first payment split as follows: Debt Counsellor Fee and legal fee and balance to creditors. If not possible to pay attorney s fees from first payment, then taken from second payment. 3 Creditor notification Creditors and credit bureaus are notified within 5 business days (Form 17.1) Although contact with creditors should stop, this may continue until such time as the notice has reached the relevant persons in the creditor offices. Please refer all queries to us. 4 Certificates of Balances Creditors are supposed to respond to Form 17.1 within 5 business day of receipt of same, with a certificate of balance, confirming account details and balances. 5 Formal assessment Once all information is received, a formal assessment of the level of over-indebtedness is done within 30 days of application All creditors and credit bureaus informed by way of Form Proposal Formal debt restructuring proposal developed within 25 business days of application and submitted to creditors Creditors should respond within 10 business days(reminder after 10 days, with another 5days to respond) Process to be completed within 60 business days 7 Court Application An application is made to the magistrate s court in the form of a request for a legal court order Magistrate s court makes the final decision 8 Client and creditors informed via Form Payments Ensure payments are done monthly to the PDA for distribution to credit providers according to repayment plan. Monitored by Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd and/or K2df Debt Counsellors (PTY) Ltd. 10 After Care Provided by Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd and/or K2df Debt Counsellors (PTY) Ltd. Annual case review to determine possible problems, and to notify creditors of any changes if necessary Service also available at any time on your request 11 Clearance Certificate Once all debt repaid through debt review process, or if you are able to settle your debt obligations Issued within 5 business days to creditors, as well as credit bureaus. Aftercare services involves: Updating PDA with revised payment plan and final payment plan, once approved by Court Updating the NCR Debt Help on progress of debt review Follow up on non-payment to Credit Providers and Debt Counsellors for aftercare and legal fees Dealing with suspensions of accounts payable to Credit Providers, including incorrect PDA data Dealing with letters of demand and terminations, received from Credit Providers Obtaining of settlement amounts, if client is in a position to settle a debt Monitoring and reminding the parties of progress on debt review application and Court date Appearance at Court, when the application is heard, if required from magistrate Annual review for financial position of client as well as any dramatic change in financial circumstance, that will impact the clients ability to repay as per accepted repayment plan and Court Order Obtaining proof of final repayment from all Credit Providers and the issuing of a Clearance Certificate (Form 19) Updating Credit Bureaus that debt has been repaid via NCR Debt Help Withdrawal of client from debt review notification of Credit Providers and updating of NCR Debt Help Aftercare DOES NOT include: Any legal action (Magistrate or High Court) or legal fees, other than the debt review application Any rescission of Judgement and/or Garnishee Orders Any legal action by Credit Providers during the debt review, resulting from non-payments by the client Any counselling outside of the financial counselling as part of the Debt Review No CASH ever to be paid at any office or to any consultant. Monthly instalments to be paid to NPDA trust account. Full Name : : Date :

10 Page 6 MORTGAGE ACCOUNTS Name of Creditor Account Number Total Estimated Amount Outstanding Current Instalment Estimated Property Market Value VEHICLE & ASSET ACCOUNTS Name of Creditor Account Number Total Estimated Amount Outstanding Current Instalment Estimated Vehicle Market Value OTHER UNSECURED DEBT Name of Creditor Account Number Total Amount Outstanding Current Instalment Unknown Creditor Information (non-standard creditors) Creditor Name Contact Tel No (if possible) Address I, (name), hereby confirm that these are the only outstanding creditors for my Debt Review application, and that to my knowledge the above amounts are the true outstanding balances owing to the credit providers :

11 Page 7 INCOME (GROSS) Salary/Pension Investment Income Income from other sources(property rental/child support) Property Rental (attach proof) TOTAL BUDGET (ANNEXURE B) CLIENT SPOUSE TOTAL PAYROLL DEDUCTIONS PAYE SITE UIF GARNISHEE MEDICAL AID PENSION PROVIDENT FUNDS RETIRMENT ANNUITIES UNION FEES OTHER TOTAL DEDUCTIONS INCOME (NETT) LIVING EXPENSES BANK CHARGES CLOTHING DOMESTIC/CLEANING SERVICES DSTV/M-NET/SATELITE EDUCATION FEES ENTERTAINMENT FOOD (GROSERIES) FUNERAL COVER GARDEN SERVICES INSURANCE HOUSEHOLD MAINTENANCE LIFE INSURANCE MEDICAL AID MOBILE PHONE RATES & TAXES PENSION PETROL/TRANSPORT PROPERTY RENTAL RETIREMENT ANNUITIES VECHILE INSURANCE WATER & LIGHTS Other TOTAL NETT INCOME MINUS TOTAL LIVING EXPENSES = REHABILITATION CONTRIBUTION Full Name : :

12 I, THE UNDERSIGNED, DECLARE AS FOLLOWS: Power of Attorney 1. I undertake to comply with all the requests from the Debt Counsellor 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 bureaux by the Debt counsellor; 3. I also consent that the Debt counsellor may obtain my credit records from any/all registered credit bureaux 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 consolidated agreement, with any credit provider until one of the following events has 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 agreements as re-arranged are fulfilled; 5. The Debt Counselling process was explained to me and I have read and understood the Debt Counselling process; 6. Debt Counselling Fees and legal fees applicable are set out in the Fee Guidelines; I understand and accept these fees. I shall accept any additional fees only when advised in writing; 7. I understand that I MUST NOT SIGN ANY DOCUMENTS whatsoever which I receive from any credit provider and shall make no promises, either verbally or in writing, to any credit provider and understand and accept that ANY payment to a credit provider will be done through NPDA by arrangement with the Debt Counsellor; 8. 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; 9. If I have any additional money that I want to pay towards my debt, I will arrange with the Debt Counsellor for the payment to be made through the NPDA, so records and interest can be adjusted by them; 10. I agree that any additional money paid will be distributed to the highest outstanding balance or to whatever the debt counsellor decides on; 11. I confirm that the information contained in this document is, to the best of knowledge, true and correct; 12. I indemnify all employees and nominees of Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd and K2df Debt Counsellors (PTY) Ltd against any claim that may be instituted against them arising from any act or omission by such person appointed by Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd and K2df Debt Counsellors (PTY) Ltd or it s nominee on the lawful execution of the terms and conditions of this agreement/power of Attorney entered into with myself, and confirm that Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd, K2df Debt Counsellors (PTY) Ltd and their directors shall not be liable for any damages suffered by me resulting from any act or omission of whatsoever nature, however arising. 13. I hereby acknowledge that all lawful actions taken by Key 2 Debt Freedom (PTY) Ltd, LCH Services (PTY) Ltd and K2df Debt counsellors (PTY) Ltd under its powers under this Power of Attorney are tacitly ratified by me, and I will be bound by such agreements as principal debtor. 14. I hereby give permission to my Debt counsellor to act as my lawful agent and to sign on my behalf all relevant documentation regarding the debt counselling process specifically any Legal documents for court application as well as the relevant court documents as requested by the court and/or the Tribunal. SIGNED AT (PLACE) ON THIS DAY OF 20 CLIENT NAME & SURNAME: ID NUMBER: APPLICANT (SIGNATURE)

13 Power of Attorney (ALL CREDIT PROVIDERS) By this Power of Attorney I undersigned, An adult female/male currently residing at hereby appoint the registered Debt Counsellor NCRDC 1978 / 2237 of K2DF (PTY) Ltd, which has its principal place of business at 27 Edward street, Vereeniging ( the Debt Counsellor ), to be my true and lawful agent and I expressly grant the Debt Counsellor full power and authority to, on my behalf: 1. Cancel any debit orders: and/or 2. Stop payments of any debit orders 3. To correspondent on my behalf to all creditors in form of /fax and telephone conversations 4. Represent me in court when obtaining a court order or by using an attorney appointed by the Debt Counsellor 5. To negotiate payment with credit providers at my best interest In order to facilitate the debt review process in terms of Section 86 of the National Credit Act, 34 of Signed at on this day of. Witness1: Full Name Customer: Full Name Witness1: Customer: Witness 2: Full Name Debt Counsellor: Full Name Witness 2: Debt Counsellor:

14 3. I confirm that I have read the affidavit of the APPLICANT, my Debt Counsellor, to which this affidavit is attached. I confirm that I am aware that these affidavits are in support of a Debt Review Application that will be brought by the APPLICANT. I confirm the contents of the founding affidavit in support of the Applications as far as it is applicable to me. 4. I further confirm that I waive service of the Debt Review Application and/or any other legal documents, all court processes, all notice and/or pleadings that need to be served on me also pertaining to further affidavits that need to filed in this application. 5. I further confirm that I have knowledge of section 88 of the National Credit Act of 2005 in that I must not incur any further charges under a credit facility or enter into any further credit agreements, other than a consolidation agreement with any credit provider until all my obligations under the credit agreements as rearranged are fulfilled. 6. I confirm that I will obey by any decision of this above honourable court regarding the Debt Review process in regards to my over-indebtedness as well as the restructuring of payments to various Credit Providers. DEPONENT I certify that the deponent has acknowledged that he/she knows and understands the contents of this affidavit which was signed and sworn to before me on this day of 20 and that the provisions of the regulations contained in government notice R1258 of 21 July 1972, have been complied with COMMISSIONER OF OATHS

15 Page 11 National Payment Distribution Agency Reg No: 2007/025383/07 93 Lyttelton Avenue, Clubview, Centurion Tel: VAT No: AUTHORISATION TO DEDUCT A MONTHLY INSTALMENT I hereby request, instruct and authorize the National Payment Distribution Agency to draw against my account with the under-mentioned bank, the sum of R The deduction should start on the (day) of (month) (year). This instruction will remain in force until I have completed the debt review. Account Details Name of Account Holder: ID Number: Name of Bank: Branch Name: Branch No: Account Number: Account Type: I confirm that my salary is paid into my bank account on the (day) of each and every month. Kindly deposit the amounts mentioned above into the following account Account Name: National Payment Distribution Agency Bank: Mercantile Bank, Trust Account Branch Code: Account no: Debt Counsellor Name: Hattingh I agree to pay any bank charges relating to this debit order instruction. I understand that my monthly repayment may increase as per the contract with my debt counsellor. I understand that I shall not be entitled to any refund of amounts which NPDA have withdrawn while the authority is in force of such amounts legally owed. I understand that I will be held liable for any costs incurred should my debit order instruction fail due to a lack of funds; NPDA has the right to recoup my monthly instalment in the following month which may result in a debt review extension assignment. I acknowledge that the party hereby authorized to effect the drawing(s) against my/our account may not cede or assign any of its rights to any third party without my/our prior written consent and that I/we may not delegate any of my/our obligations in terms of this contract/authority to any third party without prior written consent of the authorized party. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank (whichever it is or will be). Signed at: on the (day) of (month) (year) :

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