Debt Review Cancellation Application Form

Client Information Sheet - Cancellation of Debt Review

1. Your full names as reflected in your ID document are(Required)

First Name, Middle Name/s, Surname

2. ID Number(Required)

3. Phone Number(Required)

4. Are you male or female?

Female

Male

5. Email Address(Required)

Enter Email Confirm Email

6. Your current residential address(Required)

7. Please attach proof of address not older than 3 months(Required)

Max. file size: 64 MB.

8. Are you still making use of the debt counsellor's services?(Required)

YES

If you are still making use of the debt counsellor's services, you may cancel the debt counsellor's services, provided you can make direct payment to the creditors immediately.

8.1 Please attach the Form 17.W Suspension Notice provided by the debt counsellor

Max. file size: 64 MB.

Should you not have a copy of the Form 17.W in your possession, we can obtain same from your debt counsellor.

9. Did you go under debt review with your spouse?(Required)

Yes, we want to cancel jointly

Yes, but we're divorced and I want to exclude the other person

9.1 Please upload your Marriage Certificate, or Divorce Decree(Required)

Max. file size: 64 MB.

10. What was your salary at the time you went under debt review?(Required)

10.1 What was your spouse's salary at the time you went under debt review?(Required)

11. What is your current income? (as it reflects on your latest proof of income)(Required)

11.1 What is your spouse's current income? (as it reflects on his/hers latest proof of income)(Required)

12. Your current employer and your work address (the application is confidential and subject to client-attorney privilege)(Required)

12.1 Your spouse's current employer and work address (the application is confidential and subject to client-attorney privilege)(Required)

13. Your current Job Title(Required)

13.1 Your spouse's current Job Title(Required)

14. Briefly explain your circumstances as at the date you applied to go under debt review, giving reasons as to why it was necessary for you to apply for debt review in the first instance.(Required)

15. Please advise why you wish to cancel debt review and explain how your circumstances have improved since going under debt review.(Required)

16. Your Monthly Schedule of Expenses(Required)

Expense Item

Cost per month

17. Please be aware that once you cancel debt review, you will no longer have protection in terms of the National Credit Act and that the creditors may proceed to enforce a credit agreement if you do not have payment arrangements with regards to any outstanding amounts(Required)

AGREED

I DECLINE THE APPLICATION

17. How did you hear about us?

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Client Information Sheet - Cancellation of Debt Review

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Consumer Law, Credit Law, and Insolvency Law | Serving Clients Across South Africa

Client Information Sheet - Cancellation of Debt Review

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