APPLICATION TO BE CONFIRMED NOT OVER-INDEBTED AND TO REJECT A DEBT RE-ARRANGEMENT RECOMMENDATION/ORDER
Applicant details: If you are married in community of property, both spouses must apply jointly.
Main (1st) Applicant
Title*
Initials*
Identity Number*
Full Names & Surname*
Gender*
Ethnic Group*
Marital Status*
Mobile Number*
Email Address*
Address*
Province*
Postal Code*
Owner/Tenant:*
Period at Address:*
Number of dependents
Age of dependants
Separate by commas
Next of Kin Full Names*
Next of Kin Email Address*
Next of Kin Contact Number*
2nd Applicant (SPOUSE)
Title*
Initials*
Identity Number*
Full Names & Surname*
Gender*
Ethnic Group*
Marital Status*
Mobile Number*
Email Address*
Address*
Province*
Postal Code*

EMPLOYMENT DETAILS
Main (1st) Applicant
Name of Employer / Company Name*
Employment Type*
Occupation*
Gross Salary (Before Deductions)*
Total Deductions*
Total Nett Income (After Deductions)*
Pay Date*
MM slash DD slash YYYY
2nd Applicant (SPOUSE)
Name of Employer / Company Name*
Employment Type*
Occupation*
Gross Salary (Before Deductions)*
Total Deductions*
Total Nett Income (After Deductions)*

HOUSEHOLD LIVING EXPENSES
Water & Electricity*
Groceries*
Petrol / Travel*
Telephone / Cellphone*
Bank Charges*
Clothing*
School Fees
TOTAL HOUSEHOLD LIVING EXPENSES

DEBT OBLIGATIONS
Creditors Name
Creditors Name
Who is/was your debt counsellor?*
If you were married at the time you went under debt review and the debt review application was a combined application in the name of both parties (husband and wife) made?**
Why do you want your name to be removed from Debt Review.*
Kindly Provide a Detailed Motivation for the Magistrate on why should your name be Removed from Debt Review.
The approximate date you were placed under debt review*
MM slash DD slash YYYY
Is your debt review subject to a court order?*
Approximately when last did you make payments to the Payment Distribution Agency/Debt Counselor?*
MM slash DD slash YYYY
Have you received any cancellation documentation from your debt counselor?*
Your income at the time you were placed under debt review was approximately?*
Have you settled any accounts that were placed under debt review?*
If Yes. Please remember to upload paid-up letters.
For your outstanding accounts, can you afford the original installments that were due to each account before you went under debt review?*
Are you already making payments directly to your creditors?*
Are you aware of the fact that 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?*
Upload ID Copy*
Drop files here or

Max. file size: 3 GB.
Upload Recent Payslip*
Drop files here or

Max. file size: 3 GB.
Upload Proof of Address*
Drop files here or

Max. file size: 3 GB.
Not older than 3 months. Utility bill, e.g. municipal water and lights account or property managing agent statement, Medical aid statement or policy document, etc
Upload Paid up Letters
Drop files here or

Max. file size: 3 GB.
Upload 17.W (Debt Review Cancellation Letter From your Previous Debt Counsellor)
Drop files here or

Max. file size: 3 GB.
Upload Marriage Certificate
Drop files here or

Max. file size: 3 GB.

NOTE: The fee is R8550.00 vat exclusive
This is due on your pay-day or as agreed, it can be arranged and payable over 6 months. There are no upfront fees and the initial assessment is FREE!
Thank you for trusting The National Debt Review Center to help you take back control of your finances.

As discussed, we can remove your debt review listing and the fees involve will be R8550,00
To lighten the blow on your budget you can make the payment in monthly instalments of:*
- R8 550,00 once off (vat exclusive)
- R4 275.00 over 2 months (vat exclusive)
- R2 850,00 over 3 months (vat exclusive)
- R2 137.50 over 4 months (vat exclusive)
- R1 710.00 over 5 months (vat exclusive)
- R1425 over 6 months (vat exclusive)
Your Invoice for the selected payment plan will be generated once we have received your application and assessed that you qualify for debt review removal. Also note that should you select a lower than R4 275.00 payment option, your application will only be sent for legal preparation once we have confirmed 50% of your payment towards the full fee. (This further means that your application will fall out of the 3-6 months period).
I will make payment to The National Debt Review Center as indicated above.
Declaration*
I agree to the following terms and conditions.
I confirm that the information contained in this document is to the best of my knowledge true and correct and further I undertake to comply with all requests from The National Debt Review Center to assist him/her to evaluate my state of indebtedness and to investigate the prospects for responsible debt restructuring. I consent to The National Debt Review Center to obtain my credit record from any/all registered credit bureaus and any other registers which may contain any of my credit information.

I/We the Consumer(s) authorise The National Debt Review Center and it’s staff and/or agents to
process, store and keep my/our personal information that has bearing to my/our debt review removal application and whilst I/we do explicitly give my/our consent to do so, I/we understand and accept that The National Debt Review Center is obliged to act within the parameters
of the Protection of Personal information Act (“POPI”).
Signed at:*
Date*
MM slash DD slash YYYY
Signature*
Comments
This field is for validation purposes and should be left unchanged.

Debt Review Removal Online Application Form

Debt Review Removal Application Form – I want to Exit Debt Review (1)

Step 1 of 5

APPLICATION TO BE CONFIRMED NOT OVER-INDEBTED AND TO REJECT A DEBT RE-ARRANGEMENT RECOMMENDATION/ORDER

Applicant details: If you are married in community of property, both spouses must apply jointly.

Main (1st) Applicant

2nd Applicant (SPOUSE)

EMPLOYMENT DETAILS

Main (1st) Applicant

2nd Applicant (SPOUSE)

HOUSEHOLD LIVING EXPENSES

DEBT OBLIGATIONS

NOTE: The fee is R8550.00 vat exclusive