Form 16 – Consent Form

TERMS AND CONDITIONS

F O R M 16

Application by Consumer for Debt ReviewIn terms of section 86(1) of the National Credit Act No. 34 of 2005

If you are married in Community of Property (COP) or bounded to a traditional indigenous customary marriage, both of you would have to apply for debt counselling and follow the process together (joint application), irrespective of whether or not both of you are over-indebted. According to the law, when married in community of property, you are classified as one single joint estate and all your assets and debts are deemed as one estate and both of you to be jointly responsible to address credit obligations.

Definitions:
Debt Counsellor = DC ; Payment Distribution Agency = PDA

The singular includes the plural and vice versa.
a reference to any one gender, whether masculine, feminine or neuter, includes the other two.

By signing and submitting this debt review application I agree and/or undertake:

1.  On receipt of this application the DC will advise all credit providers and all registered credit
   bureaus accordingly
2. Credit bureaus to confirm my debt review status on their records.
3. All sections of this Form 16 (debt review application) to be completed in full and must be accompanied by the following supporting documents: copy of ID Document(s), proof of income, banking statements for the last 3 months, marriage certificate, antenuptial contract (if applicable) and proof of current residential address (such as any utility billing, dated < 3 months).
4. To indemnify the DC against all loss or damage you may sustain as a result of this application in terms of Section 86 of the National Credit Act 34 of 2005.
5. To comply with all requests from the DC to assist him to evaluate your state of indebtedness.
6. I am authorizing the DC to obtain/retrieve your credit record from any/all registered credit bureaus and any other registers which may contain any of your credit information.
7. The DC may cancel relevant debit orders, and/or stop payments of any debit orders.
8. I am permitting the debt counsellor to approach a duly registered financial advisor to substitute existing credit life insurance or add new credit life insurance should this replacement boils down to a reduction of monthly expense and/or elevated/expanded credit cover.
9.  I undertake not to enter into any further credit agreement, with any credit provider until one of the following events has occurred:
   a. The debt counsellor rejects my application.
   b. The court determines that I am not over-indebted; or
   c. All my obligations under credit agreements as re-arranged are fulfilled.
10. I confirm that the information contained in this document is, to the best of your knowledge true and correct and has been given out of own free will and I hereby consent to the disclosure of my personal information for the purpose of which it was collected and it may be disclosed to third party operators such as Credit Providers and their agents, Credit Bureaus, National Credit Regulator and any other party which may form part of this debt review application process.
11. I undertake to inform the DC of any changes in my residential address, telephone numbers, email address(es), employer and/or income.
12. To open a new savings account with a financial institution with whom I don’t have any current affiliation and to request my HR department to transfer my salary into this newly opened bank account. I understand this is done, to ensure my credit providers do not collect monthly installments by debit order as they will get paid by the PDA as from day of this application. I will furthermore ensure, relevant service providers who I intent to sustain while being under debt review, such as policies, medical fund etc. to be switched to my bank account, while I shall refrain furnishing any creditors with my new banking details for reason explained above. I furthermore undertake to attempt with my DC to cancel all creditor related debit orders linked to my current account in order to prevent admin costs that will accumulate due to a lack of funds as my salary now to reflect in my new account. I also undertake to close this dormant account asap for reason mentioned above.
13. I confirm that I am fully aware of the implications of going under debt review and that the debt counsellor has explained the pros and cons pertaining to the process to me and what the process entails including the duties of the debt counsellor as per the below:

APPLICATION PROCESS:

• Client interview and assessment
• Evaluation of affordability
• Discussion of debt review process
• Processing of debt review files
• Obtaining of Certificates of balance
• Sending form 17.2 to all credit providers
• Arranging for PDA loadings to ensure correct timeous repayments to creditors.

PROPOSAL PREPARATION AND COMPLETION

• Proposal preparation
• Dealing with proposal responses

LEGAL PREPARATION:

• Produce documents as per specific court requirements.
• Affidavits, commissioner of oaths
• Queries from credit providers and attorneys
• Court Appearance
• Notify credit providers through form 17.2C after granting of consent order/court order.
• Update NCR Debt Help System

AFTER CARE SERVICE INVOLVES:

• Updating the PDA with revised payment plan and final payment plan once approved by Court.
• Updating the NCR Debt Help on progress of debt review.
• Follow up on non-payment to Credit Providers and Debt Counsellors for aftercare and legal fees.
• Dealing with suspensions of accounts payable to Credit Providers including incorrect PDA data
• Obtaining of settlement amounts if the client is in a position, to settle a debt.
• Monitoring and reminding the parties of progress on debt review application and Court Date
• Appearance at Court when the application is heard, if required by Magistrate
• Annual review for financial position of client as well as any dramatic change in financial circumstance that will impact the client’s ability to repay as per accepted repayment pan and Court Order
• Obtaining proof of final repayment from all Credit Providers and the issuing of a Clearance Certificate (Form 19)
• Updating Credit Bureaus that the debt has been repaid via NCR Debt Help

AFTER CARE DOES NOT INCLUDE:

• Any legal action (Magistrate or High Court) or legal fees other than the debt review application
• Any rescission of Judgments and/or Garnishee Orders
• Any legal action by Credit Providers during the debt review resulting from non-payments by the client.
• Any counseling outside of the financial counseling as part of the Debt Review

14.  I understand that I cannot withdraw voluntarily from the debt review process once this application has been submitted as stipulated in the NCR withdrawal guidelines.

15. I understand the debt counsellor to reject this application should over-indebtedness not apply.

16. The debt counsellor to furnish me with a monthly amount which I will transfer to the Payment Distribution Agent (DC-Partner) to address payments among my creditors once the debt counsellor and legal fees (as per clause 20 – 23) have been addressed. I understand this monthly amount may vary in future based on the outcome of the repayment plan submitted to my creditors.

17. We understand the affiliated PDA (DC-Partner) to oversee monthly distribution in favor of our creditors by distributing our consolidated monthly payment amongst these creditors at a fee which is calculated as
follows:

• Small payments less than R200 will be charged R5 (VAT incl)
• Medium payments (R200 – R500) will be charged R10 (VAT incl)
• Larger payments over R500 will have a charge of R15 (VAT incl).

18. The Debt Counselling applicable fees and related debt counseling services were disclosed to me namely, a once off application fee of R 50.00 (excl.VAT) due by me at time of application and a once off administrative fee of R300.00 (excl. VAT) due by me, once over indebtedness has been assessed. A restructuring fee that is equal to the monthly debt review contribution as determined during the construction of the preliminary payment plan, with a maximum of R8000.00 (Excl. VAT) for a single application and R 9000.00 (Excl.VAT) for a joint application, paid in the first month of my debt review and that we consent to these fees to be paid to the Debt Counsellor via the appointed Payment Distribution Agency (DC-Partner) except the application and administration fees which have to be paid upfront by us, once consultation once over indebtedness has been assessed.

19. The debt counsellor has explained the DC After Care Fee equal to 5% of my monthly debt review contribution amount with a maximum of R450.00 excluding Vat and overseen by the PDA as from second monthly distribution till completion of the process.

20. The DC by means of the PDA to furnish me with a monthly distribution breakdown pertaining to my monthly payment done to the PDA.

21. The Debt Counsellor has informed me, a Legal Officer to be appointed on my behalf to refer this debt review application to court, should all the creditors not agree with the proposed restructured repayment plan or the National Consumer Tribunal to be approached for a consent order should all creditors do agree with proposed restructured repayment plan.

22. The legal fee was disclosed to me namely R2700.00 (excl. VAT) should the legal officer has to approach court or else a reduced fee to apply should the application be referred to the National Consumer Tribunal (“NCT”) in which event the legal fee will be limited NCT upload fee (R577.81 for period 01/04/2023 – 31/03/2024) and admin fee of R500.00 + Vat to and we have consented to these fee to be paid via the appointed and accredited Payment Distribution Agency (DC-Partner).

23. We have consented that all communication between the Debt Counsellor and me (and any other 3 rd parties involved in the debt review process) may be conducted in English and all formal written procedures in the debt review process to be conducted in English as well.

24. The Debt Counsellor has reiterated that the debt counsellor cannot give any financial advice to the applicant regarding investments, insurance, and the purchasing or variation of financial products unless the Debt Counsellor is registered with the Financial Service Board to give advice as is required by the Financial Advice and Intermediary Service Act (FAIS), Act 32 of 2002 but the Debt Counsellor may approach a duly registered financial advisor to assess current financial products of the applicant and to replace some or all of these products should it be to the benefit of the applicant.

25. To prevent termination of the debt review process, I hereby undertake not to use any further credit available and not to apply for any further credit while I am under debt review and to sustain all credit insurance pertaining to credit agreements.

I hereby confirm the information supplied by me on this application, to be true and correct, to the best of my knowledge. I furthermore confirm that I have disclosed all my creditors on this application and understand that an omission to disclose a creditor may result to the account being excluded from this debt review process.