APPLICATION BY CONSUMER FOR DEBT REVIEW In terms of section 86 of the National Credit Act 34 of 2005 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; 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. PART 1 PERSONAL INFORMATION APPLICANT FULL NAMES AND SURNAME: IDENTITY NUMBER: RESIDENTIAL ADDRESS: POSTAL CODE: PERIOD AT ADDRESS: POSTAL ADDRESS: POSTAL CODE: TELEPHONE NUMBER (WORK): TELEPHONE NUMBER (HOME): CELL PHONE NUMBER: E-MAIL ADDRESS: OCCUPATION: PERIOD OF EMPLOYEMENT: NAME OF EMPLOYER: ADDRESS OF EMPLOYMENT: SPOUSE MARRIED: COP / ANC DATE MARRIED: FULL NAMES: IDENTITY NUMBER: TELEPHONE NUMBER-(WORK): CELL NUMBER: E-MAIL ADDRESS: OCCUPATION PERIOD OF EMPLOYMENT: NAME OF EMPLOYER: ADDRESS OF EMPLOYMENT: HOME OWNER TENANT LODGER HOW LONG AT CURRENT ADDRESS: BANKING ACCOUNT DETAILS: NAME OF ACCOUNT HOLDER: BANK: BRANCH: ACCOUNT NUMBER: BRANCH NUMBER: PHONE: 031 2092356/084 2502356 FAX: 086 573 2433 E-MAIL: romie@debtfinesse.co.za [1]
NUMBER OF DEPENDANTS: (Please attach a copy of your salary slip) PART 2 - INCOME DETAILS DETAILS APPLICANT SPOUSE GROSS SALARY OTHER INCOME SUBTOTAL 0 0 DEDUCTIONS: TAX UIF MEDICAL AID PENSION OTHER DEDUCTIONS SUBTOTAL 0 0 NET INCOME 0 0 PART 3 MONTHLY COMMITMENTS (Please list all monthly commitments other than outstanding debts, i.e. school fees, travel costs, medical expenses, etc) COMMITMENT AMOUNT ADJUSTED AMT RENT ELECTRICITY WATER TRAVEL TELEPHONE INSURANCE PREMIUMS SCHOOL FEES MAID GROCERIES MEDICAL EXPENSES TOTAL EXPENSES 0 0 PHONE: 031 2092356/084 2502356 FAX: 086 573 2433 E-MAIL: romie@debtfinesse.co.za [2]
PART 4 DEBT OBLIGATIONS (Please provide copies of all outstanding balances due Creditor information) DEBT TYPE INSTITUTION ACCOUNT NO. MONTHLY AMOUNT INTEREST COMMITMENT OUTSTANDING RATE I declare as follows: PART 5 Declaration by the Consumer 1. I undertake to comply with all 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 bureaus by the debt counsellor; 3. I also consent that the debt counsellor may obtain my credit record 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 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. I undertake to honour the debt re-arrangement agreement and to ensure that the monthly creditor payments are made via the nominated payment distribution agency by no later than 3 months from date hereof. 6. I undertake to pay the debt counselling and legal admin fees to my debt counsellor as agreed. 7. I confirm that I have received a copy of the completed application form together with a receipt, confirming that I have applied for Debt Counselling, from my debt counsellor. Signed at [place] on this [day] of [month] of 20 SIGNATURE: SIGNATURE: PHONE: 031 2092356/084 2502356 FAX: 086 573 2433 E-MAIL: romie@debtfinesse.co.za [3]
Information Sheet for New Debt Counselling Clients Value (Excluding VAT) Frequency 1. Application fee R 50.00 Once off (On application) 2. Professional Debt Counselling Assessment Fee Renegotiation amount limited to a Once off (Month 1) maximum of R6000 3.Document Preparation Fee to refer debt review R1500.00 Once-off (Month 2) application to Court/NCT for Consent Orders 4. Legal Fees If consents not received from all credit providers R1500.00 R3500.00 Payable directly to Attorneys (month 1 or by arrangement) 5. Aftercare fee for 24 months 5% of negotiation amount Monthly 6. Aftercare fee for remaining period 3% of negotiation amount Monthly 7. Payment Distribution Agency (PDA) fee 3% of distribution amount Monthly Note that the following will apply in the case of: Rejection R 300.00 Once-off Cancellation fee (75% of Professional assessment fee) 75% of Renegotiation amount limited to a maximum of R4500.00 Once-off *Should your Debt Counsellor be able to obtain 100 percent consent from all Credit Providers a Consent Order can be obtained and this will result in a reduced legal fee. All legal fees are subject to consumer s written consent. The following services will be offered for these fees: The initial professional assessment involves: Application process: Client interview and assessment Evaluation of affordability Discussion of debt review process Processing of debt review files Obtaining Certificates of Balance Sending Form 17.2 to all credit providers Arrange for PDA loadings to ensure correct timeous repayment Proposal preparation and completion & Dealing with proposal responses. Document Preparation Fee and Legal Fees: Produce documents as per specific court requirements Affidavits, commissioner of oaths Queries from credit providers and attorneys Court appearance Notify credit providers through Form 17.2C after granting of consent order Update NCR Debt Help System The aftercare service 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 termination received from Credit Providers Obtaining of settlement amounts if the 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 by 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. After Care does not include: Any legal action (Magistrate or High Court) or legal fees other than the debt review application Any rescission of Judgments 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 PHONE: 031 2092356/084 2502356 FAX: 086 573 2433 E-MAIL: romie@debtfinesse.co.za [4]
POWER OF ATTORNEY I/We, the undersigned, declare as follows: 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/Document Preparation 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 DOCUMENT whatsoever which I receive from any credit provider and shall make no promises, either verbally or in writing, to any credit provider and understand that ANY payment to a credit provider will be done through the 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 confirm that the information contained in this document is, to the best of my knowledge, true and correct. 11. I indemnify all employees and nominees of Finesse Debt Counsellors against any claim that may be instituted against it or them arising from any act or omission by such person appointed by Finesse Debt Counsellors or it's nominee in the lawful execution of the terms and conditions of this agreement/power of Attorney entered into with myself, and confirm that Finesse Debt Counsellors shall not be liable for any damages suffered by me resulting from any act or omission of whatsoever nature, however arising. 12. I hereby acknowledge that all lawful actions taken by Finesse Debt Counsellors under its powers under this Power of Attorney are tacitly ratified by me, and I will be bound by such agreements as principal debtor Signed at on this, the day of 20 MAIN APPLICANT SPOUSE PHONE: 031 2092356/084 2502356 FAX: 086 573 2433 E-MAIL: romie@debtfinesse.co.za [5]
DEBT COUNSELLING FEE STRUCTURES (exclusive of VAT) The Debt Counsellor may charge the following amounts:- 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 Consumers whose applications have been rejected in terms of S 86(7)(a) of the NCA. 3. A restructuring fee of the lesser of the first instalment of the debt rearrangement plan or R6 000-00 (excl. VAT), in respect of a Consumer whose application has been accepted in terms of S 86(7) (b) or S 86(7)(c). This fee will be included in the restructuring process. An aftercare fee of 5% pm (excl. VAT) on the monthly instalment of the Debt Rearrangement Plan up to a maximum of R400-00 (excl. VAT) for the first 24 months, after which a fee of 3% pm on the monthly instalment up to a maximum of R400-00 (excl. VAT), for the remainder of the Debt Rearrangement Plan. Payment distribution agent fees of 3% of the distribution amount - limited to a minimum of R50 (excl VAT) and a maximum of R500 (excl VAT) per month. All fees are built into your debt restructuring and repayment proposal. 4. Should the Consumer withdraw from the process after the proposals have been submitted a fee equal to 75% of the restructuring fee is payable to the Debt Counsellor. 5. In order to obtain a consent order or court order, an attorney must be appointed. Legal/Document Preparation fees payable for this process will be between R2500 (excl VAT) and R4500 (excl VAT). The exact amount will be confirmed as soon as the full assessment has been undertaken i.e. after the certificates of balances have been obtained from all creditors. SIGNED AT (PLACE) ON THIS DAY OF 20 APPLICANT DEBTCOUNSELLOR/CONSULTANT Name: Romie Govender (NCRDC 1262) ID Number: ELECTRONIC PAYMENTS TO : FNB CHEQUE A/C#55139005588; BRANCH#250655 INO R GOVENDER IN RESPECT OF Debt Counselling and Document Preparation Fees(Month 1 and 2) CREDITOR PAYMENTS ELECTRONICALLY TO NPDA TRUST A/C#1454119233 HELD at NEDBANK RIVONIA BRANCH#149745. PLEASE USE YOUR ID NUMBER AS THE REFERENCE NUMBER. (From month 3 onwards) Kindly note that failure to make 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 debt enforcement action taken by your credit providers. PHONE: 031 2092356/084 2502356 FAX: 086 573 2433 E-MAIL: romie@debtfinesse.co.za [6]