Debt Assessment

Please Note: This does not sign you up for anything, this will simply help our qualified consultants to assess your situation and contact you back with a solution to your debt problems.

If you are married in community of property, both spouses must be assessed jointly. Please insert a 0 if a field is blank or if you are unsure.

Step 1 of 6

Main (1st) Applicant
Title*
Initials*
First Names*
Surname*
Identity Number*
Gender*
Ethnic Group
Marital Status*
Mobile Number*
Email Address*
Province*
Address*
Dependent Details
Number of Dependents
Ages and Gender (M/F) of Dependents

Use a comma to separate the ages and gender eg. 1F,4M,9F,16M
If your dependents are minors, to what extent are you supporting them?
2nd Applicant (Spouse)
Title*
Initials*
First Names*
Surname*
Identity Number*
Gender*
Ethnic Group
Mobile Number*
Email Address*
Province*
Address*

Main (1st) Applicant
Name of Employer*
Employment Type*
Occupation/Job Title*
2nd Applicant (Spouse)
Name of Employer*
Employment Type*
Occupation/Job Title*

Main (1st) Applicant
Please insert a 0 if a field is blank or if you are unsure.
Gross Salary(Before Deductions)*
Commissions
Overtime
Pension Income
Property Rental Income
Other Income
Total Income
Reason for Over-Indebtedness*
Reason for Over-Indebtedness - Other

Please specify.
2nd Applicant (Spouse)
Gross Salary(Before Deductions)*
Commissions
Overtime
Pension Income
Property Rental Income
Other Income
Total Income

Main (1st) Applicant
Please insert a 0 if a field is blank or if you are unsure.
Funeral Policies
Garnishees/Admin Orders
Insurance
Medical Aid
Loans
Pension Fund
Tax*
UIF*
Total Pay Slip Deductions
2nd Applicant (Spouse)
Please insert a 0 if a field is blank or if you are unsure.
Funeral Policies*
Garnishees/Admin Orders
Insurance
Medical Aid
Loans
Pension Fund
Tax*
UIF*
Total Pay Slip Deductions

Main (1st) Applicant
Please insert a 0 if a field is blank or if you are unsure.
Domestic/Cleaning Service*
Educational Fees*
Groceries*
Rent/Home Ownership Cost*
Medical Expenses*
Petrol/Travel*
Security*
Telephone*
Water & Electricity*
Bank Charges*
Clothing*
Mobile Phone*
Municipal Rates and Taxes*
Vehicle Insurance*
Other Living Expenses
Total Living Expenses
Balance Available To Service Debt (Total Income Less Total Payslip Deductions, Less Total Living Expenses)
2nd Applicant (Spouse)
Please insert a 0 if a field is blank or if you are unsure.
Domestic/Cleaning Service*
Educational Fees*
Groceries*
Rent/Home Ownership Cost*
Medical Expenses*
Petrol/Travel*
Security*
Telephone*
Water & Electricity*
Bank Charges*
Clothing*
Mobile Phone*
Municipal Rates and Taxes*
Vehicle Insurance*
Other Living Expenses
Total Living Expenses
Balance Available To Service Debt (Total Income Less Total Payslip Deductions, Less Total Living Expenses)

Main (1st) Applicant
Please type the names of creditors that you have accounts with
We will get a free credit report to confirm all debt.
Creditors Name

e.g. FNB Personal Loan
Creditors Name

e.g. Markham
2nd Applicant (Spouse)
Please type the names of creditors that you have accounts with
We will get a free credit report to confirm all debt.
FNB Personal Loan

e.g.Foschini
Creditors Name

e.g. Woolworths
*
- I accept the terms and conditions and give permission to use my ID number to obtain my credit report.

Debt Assessment

Step 1 of 6

Main (1st) Applicant

Dependent Details

2nd Applicant (Spouse)

Main (1st) Applicant

2nd Applicant (Spouse)

Main (1st) Applicant

2nd Applicant (Spouse)

Main (1st) Applicant

2nd Applicant (Spouse)

Main (1st) Applicant

2nd Applicant (Spouse)

Main (1st) Applicant

2nd Applicant (Spouse)