Consent Form - NewLife4u

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DEBT COUNSELLOR

Consent

HEREBY GIVE MY/OUR CONSENT:

1. PROCESS (USE) MY/OUR PERSONAL INFORMATION IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT (POPIA)

2. REQUEST/OBTAIN A CREDIT REPORT ON MY/OUR BEHALF WITH THE OBJECTIVE TO
PERFORM AN AFFORDABILITY ASSESSMENT RELATING TO MY/OUR DEBT
EXPOSURE.

I/We the undersigned

(FULL NAMES & ID / PASSPORT NUMBER(s))

HEREBY GIVE MY/OUR CONSENT:

HEREBY GIVE MY/OUR CONSENT: for the processing (use) of our personal information by Threefold Debt and Property Solutions cc 2006/055230/23 t/a NewLife4u Debt Counselling Services (“The Debt Counsellor”) for assisting me/us to find a suitable solution to address my/our current personal financial over-indebted state of affairs. This consent authorizes the Debt Counsellor and it’s staff and/or agents to process, store and keep my/our personal information that has bearing to my/our debt review which specifically includes the right to work with my/our bank account details as and when required to ensure that I/we receive payments or refunds due to me/us and whilst I/we do explicitly give my/our consent to do so, I/we understand and accept that my/our debt counsellor is obliged to act within the parameters of the Protection of Personal Information Act (“POPIA”). • Request/obtain a credit report on my/our behalf with the objective to perform an affordability assessment relating to my/our debt exposure.

I have read, understand, and voluntarily agree to the above.

Consent

I have read, understand, and voluntarily agree to the above.

Name

Surname

Mobile Number

Telephone Number

SIGNED AT

Date

CUSTOMER (1): Signature

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CUSTOMER (2): Signature

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On receipt of this application the debt counselor will advise all credit providers and all
registered credit bureaus that you have applied for debt review

DEBT COUNSELLOR

Consent

HEREBY GIVE MY/OUR CONSENT:

YOU CAN ACHIEVE …

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DEBT COUNSELLOR CONSENT