I,, ID number and (spouse if. applicable), ID number hereby. acknowledge that I/we am/are currently unable to meet my/our monthly commitments towards

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1 POWER OF ATTORNEY Part 1 - Power of Attorney Allocation Details: Debt Counsellor Trading Name: Debt Inc Debt Counsellor Contact Person: NCR Reference No: NCRDC Business Registration No: 2010/003722/07 Address: Office Contact No: Address: 4 Voortrekker Street,, Western Cape Part 2 - Power of Attorney I,, ID number and (spouse if applicable), ID number hereby acknowledge that I/we am/are currently unable to meet my/our monthly commitments towards my/our credit providers and have applied for debt Review. 1. The Process of debt review and the role of the debt counsellor have been fully explained to me/us and are clearly understood by me/us. I/we understand that whilst under debt review and during the debt restructuring plan, I/we am/are unable to incur any further debt. I/we understand that I/we can only apply for credit once a clearance certificate is issued by the debt counsellor. 2. It is understood that Debt Inc will include the following credit agreements in the debt review process: 2.1 Home loans 2.2 Vehicle Finance 2.3 Credit Card / Store Cards

2 2.4 Personal Loans 2.5 Overdrafts 2.6 Micro Loans If a credit agreement is summonsed before application for debt review, then this agreement needs to be excluded from the debt review process and alternative payment arrangements needs to be made by the consumer. Debt Inc shall have the following powers, for the purposes mentioned above: To obtain and disclose all information regarding my financial position to/from credit providers, credit bureaus and their legal representatives; 3.2 To provide credit reference agencies with regular updates about the conduct of my/our accounts, including the failure to meet the agreed terms and conditions; 3.3 That Debt Inc may make available the client s credit record and/or defaults to other credit grantors; 3.4 To negotiate a debt restructuring plan with my credit providers; 3.5 To cancel any authority given by me/us to my credit providers prior to this agreement that may be necessary to improve my financial situation; 3.6 To apply to the magistrates court for a consent order or for a court order according to the debt restructuring plan; 3.7 Not to conclude any agreements with my credit providers which may unfairly prejudice my rights as a consumer. I/we agree to pay Debt Inc the fees as explained to me/us, which are calculated as follows: (All fees are exclusive of VAT) A restructuring fee of one hundred percent (100%) of my first instalment of debt rearrangement plan (minimum R up to a maximum of R ). 4.2 A monthly after care fee of 5.00% of the monthly rehabilitation amount (a maximum of R400.00), for a period of 24 months. There after reducing to 3.00% of the monthly instalment to a maximum of R400.00, for the remaining period of the debt re-arrangement plan. 4.3 I/we acknowledge that the fees referred to in (4.1; 4.2) above may be deducted from my/our monthly payment to the Payment Distribution Agency (PDA).

3 4.4 Should you withdraw (voluntary or involuntary) from the debt review process after being accepted in terms of sec 86(7)(b) or (c) of the National Credit Act and after paying your restructuring fee as per 5(b), a termination fee equal to 75% of the restructuring fee is payable, in the event of the restructuring fee as per 5(b) has not been paid, this and the termination fee shall be payable by the consumer. 4.5 It is acknowledged that these fees may vary from time to time due to Industry and; 4.6 National Credit Regulator changes and that the consumer will be liable for such increases as Debt Inc deems fit to impose. 5. In the event of a consent order or court order being granted, it is the client s responsibility to make sure the payments as part of this order are made every month for the duration of the repayment plan. If the order needs to be rescinded for any reason, then all costs are for the consumers account. 6. In the event of Debt Inc having to instruct an attorney and/counsel to institute alternatively to defend/ oppose any proceedings in the High Court of the Republic of South Africa, the consumer agrees and undertakes to be personally liable for payment hereof. Please note that Debt Inc will not act on such an instruction unless requested by the client to do so and we reserve the right to charge a minimum deposit before continuing. 7. I/we indemnify all employees and nominees of Debt Inc against any claim that may be instituted against it arising from any act or omission by such person appointed by Debt Inc or its nominee in the lawful execution of the terms and conditions of this agreement/ power of attorney entered into with myself/ourselves, and confirm that Debt Inc shall not be liable for any damages suffered by me/us from any act or omission of whatsoever nature, however arising. 8. Debt Inc will advise on the client's budget and will determine an affordable amount that can be used to pay the creditors, known as the rehabilitation amount. The client is required to confirm their acceptance to the budget and rehabilitation in writing via or by the signing of the applicable pro forma or final invoice. 9. Debt Inc shall produce a list of debt obligations that are to be included in the debt review. The client is required to confirm the details and their acceptance of the debt obligations, telephonically, via or via faxed signed confirmation. 10.

4 The client is obligated to open a savings account with a banking institution where he does not have any current debt obligations towards to the bank. 11. I acknowledge that I have not, nor will not, whilst I am under debt review by Debt Inc, engage the services of any other debt counsellor or debt assistance entity and that the debt review with Debt Inc would have to be cancelled and cancelation charges paid as per 4.6 before finding a new debt counsellor. 12. I/we acknowledge that whilst I/we am/are under debt review I/we will/shall not incur any further debt or enter into any further credit agreements. I/we acknowledge that it is my/our responsibility to disclose to Debt Inc any change to my employment status and/or any additional income that I receive during the debt review process. Such additional income includes, but not limited to inheritances, bonuses, dividends, commissions and surpluses subsequent to the sale of an asset. 13. If I/we do not punctually pay any of my monthly payments to the payment distribution agency in terms of my/our debt plan, Debt Inc shall be entitled to terminate this agreement and charge the termination fees as described in 5(f). 14. I/we hereby instruct Debt Inc to take whatever legal steps they deem necessary to improve my/our ability to meet my/our financial monthly commitments towards my credit providers, it is understood that once the matter is handed over to the Magistrates court the final decision is that of the magistrate and Debt Inc cannot be held liable for the decision the magistrate makes. 15. It is acknowledge that the Magistrate Court may insist on the debt counsellor being present at court and that the appearance and travel costs for the debt counsellor be payable by the consumer. 16. As part of the debt review process, it is the credit provider s requirement that secured assets (vehicles & homes) that are financed are fully insured. 17. I/we hereby acknowledge that all lawful action taken by Debt Inc under its power of this Power of Attorney are tacitly ratified by me and I will be bound by such agreements as principal debtor.

5 Part 3 - Declaration and Acceptance Details I, and (spouse if applicable), declare that: a) All the information in this document is true and correct b) That I have read and understood the terms and conditions of this agreement/power of attorney and signed the agreement out of my own free will. Date Accepted: Signature: Signature (spouse):

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