Insolvensies

Please fill in the form below to apply

ID Number

Please verify your identification number for accuracy? Our records indicate that it is already on file within our system. If you are a returning client initiating a new application process, please proceed with the application form.

Full Names AND SURNAME as on your ID

Nickname

Previous Surname

What's your gender?

Contact Cell

Contact Home

Contact Work

Physical address

Personal information/Occupation

Pers. Description Rehab.

Name of next of kin

Next of kin contact number

Marital Status

Married out of community of property with?

Married out of community of property (Spouses ID Number)

Date of Marriage (YYYY-MM-DD)

Rehabilitation Address

Place of Birth

2^nd Applicant:

ID Number

FULL NAMES AND SURNAME AS ON YOUR ID

Nickname

Previous Surname

Contact Cell

Contact Work

Physical address

Personal information/Occupation

Pers. Description Rehab.

Name of next of kin

Next of kin contact number

PERSONAL INFORMATION

Nett salary (after deduction) 1st Applicant:

Is the salary fixed or commission based?

In event of commission state the average for the past 3 months?

Nett salary (after deduction) 2nd Applicant

Is the salary fixed or commission based 2nd Applicant?

In event of commission state the average for the past 3 months 2nd Applicant?

Do you receive maintenance and how much?

Do you pay maintenance – if yes how much?

Number of children

Age of children

Monthly School fees

Day Care/Additional education/Other activities

Transport cost for children (bus / Lift Club)

Study costs (University) and book fees

Boarding Costs

HOUSING COSTS

Rent per month

Municipal Accounts per month

Do you receive rent, how much?

MEDICAL EXPENSIS

Do you have a medical aid fund?

Additional medical expenses?

What is the monthly instalment if not subtracted from your employer?

Is one of your dependants suffering due to a medical condition (diabetic / cardiovascular / blindness / deaf / etc)

MONTHLY EXPENSIS

Monthly groceries costs (Milk; bread; meat etc): (estimated costs)

Do you borrow a vehicle - if yes where?

How much do you pay monthly for the vehicle

Average petrol costs/month

Funeral policy monthly instalment

Amount for life insurance (life cover)

Amount for household and car insurance

Car tracing system (Tracker / Net star)

Cellular phone expenses

Form your cellular outstanding amount part of the debt?

Internet / data fees

FINANCIAL HISTORY

Have you already applied for debt counselling, if Yes, where did you apply?

Was a court order issued for you debt counselling?

Court order year issued for you debt counselling

What is/was the instalment?

Have you ever been sequestrated?

If yes state year?

PROPERTY INFORMATION

Do you have a property registered in your name or a bond?

Have property with bond

No Property - Renting

Have property without a bond

Have more than one property, (Provide information on all properties)

VEHICLE INFORMATION

Vehicle 1:

Fabricate

Registration number

Hire Purchase or Lease or paid up

Monthly instalment

Financed By (which bank)

Is the payment up to date?

Is the vehicle already reprocessed? When?

Vehicle 2:

Fabricate

Registration number

Hire Purchase or Lease or paid up

Monthly instalment

Financed By (which bank)

Is the payment up to date?

Is the vehicle already reprocessed? When?

Reasons for Sequestration

PLEASE PROVIDE US WITH THE REASONS THAT CAUSED THE FINANCIAL PROBLEMS YOU ARE FACING AT PRESENT. Provide all details that caused your situation – it is of utmost importance to be specific regarding the information that caused your financial problems - you must include all aspects such as - maintenance paid, caring and financial support given to relatives, unforeseen expenses, retrenchment, medical expenses not covered by medical aid. PLEASE NOTE that a proper list of reasons must be submitted to the High Court. Stating that your Expenses is more than your Income is not sufficient.

MY DEBT

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Documents

Copy of ID document or Passport

Receipt for Rent paid or Rental Agreement

Salary slip

Maintenance payments (if applicable)

School / University / College Fees

Payment of after care or extra mural activities

Water & Electricity / Municipal accounts

Proof of Medical Aid payments

Proof of Medical expenses not paid by Medical Aid

Proof of monthly car rental

Cell phone accounts / pre-paid slips

Proof of monthly payments for Debt Counselling

We do need the latest statements of all creditors. If you do not receive any statements, please request the redemption amount from your creditors. If any of your accounts were handed over, please furnish us with a statement from the Attorneys.

Any other monthly payments

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