FORM 16 - APPLICATION FOR DEBT REVIEW IN TERMS OF SECTION 86 OF ACT 34/2005 NEW NATIONAL CREDIT ACT
Surname :
ID Number:
Spouse :
Surname :
ID Number :
First Name :
Second Name:
Joint Application :
No
yes
First Name :
Second Name :
Address :
Street :
City :
Code :
Property Status :
Owner
Tenant
Lodger
Marital Status:
Single
Engage
Common Law
Married COP
Married ANC
Married Other
Divorced
Separated
Widowed
Gender M / F :
Male
Female
Dependants :
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
P.O Box :
City :
Code :
Employer Detail
Employer Name :
Position Held :
No of Years :
Employer Postal Address
P.O Box :
City :
Code :
Property Status :
Weekly
Fortnightly
Monthly
Employer Physical Address
Street :
City :
Code :
Budget - Income
Applicant
Co-Applicant
Nett Salary / Pension
Grants
Rental Income
Investment Income
Other
Budget - Expenses
Bond(s)/Rental(s)
Levy
Rates & Taxes
Water & Electricity
Vehicle Instalments
Petrol/Car maintenance
Insurance/Assurance
Groceries
Clothing
Domestic help
Garden Services
Education
Telephone
Medical expenses
Household Security
Other
10% Contingency
CREDITOR DETAIL (OBLIGATIONS)
Creditor
Example
Type
Credit Card
Date
1 May 06
Installment
Rs.500.00
Balance
Rs.8000.00
Add More
Special Requests
Confirm Initials and Surname
Accept
