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DEBT REVIEW APPLICATION FORM

Take the first step to Financial Freedom

The benefits that you will enjoy through SA DEBT HELP:

  • you will only pay one affordable monthly instalment;
  • you will have sufficient funds for living expenses;
  • instalment amounts are reduced;
  • repayment periods get extended;
  • credit providers communicate with us, not with you;


In order for you start experiencing the benefits provided by SA DEBT HELP, please send the following documents back to us as soon as possible:

  • the completed and signed Application Form, with the signed Power of Attorney and Debit Order Authorisation (attached hereto);
  • copy of your ID (and your spouse's ID if married in Community of Property);
  • copy of your latest pay slip (and your spouse's if applicable).


Once all of these documents have been received, we will proceed to finalise your application.
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Full Name:*
ID Number:*
Number of Dependants
Ethnic Group:
Surname:*
Language Preference:*
Dependants Age:
Marital Status:*

Contact Details

Physical Address:*
E-mail Address:*
Work Number:*
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Home:*
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Cell :
Fax:
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Employment Details
Employer Name:
Employer Address:
Job Title:
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Spouse Name:
Spouse ID:
Cell No:
Employer:
Address (Employer):
Spouse Surname:
Tel No: (W):
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Name:
Tel No:
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Relationship:
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A. Income

Gross Income (Main Applicant):
Commission (Main Applicant):
Overtime (Main Applicant):
Rental Income (Main Applicant):
Child Maintenance Income:
Total Income (Main Applicant)
Gross Income (Spouse):
Commission (Spouse)
Overtime (Spouse)
Rental Income (Spouse):
Child Maintenance Income (Spouse)
Total Income (Spouse):

B. Salary Deductions

PAYE (Main Applicant):
UIF (Main Applicant):
Pension/Provident Fund:
Medical Aid
Garnishee Orders:
Staff Loans:
Other:
Total Deductions:
Nett Salary (A - B):
PAYE (Spouse):
UIF (Spouse):
Pension / Provident Fund
Medical Aid (Spouse):
Garnishee Order:
Staff Loans (Spouse)
Other (Spouse):
Total Deductions (Spouse):
Nett Salary (A-B:

C. Living Expenses

Food / Groceries / Clothing:
Property Rental:
Water / Electricity / Rates / Levies:
Security:
School Fees:
Short Term Insurance:
Vehicle Insurance:
Life Insurance:
Child Maintenance:
Fuel/Transport:
Medical Costs:
Telephone & Internet:
Legal Accounts (excluded from Debt Review):
Other:
Total Expenses:
Amount Available For Debt Review (Nett Salary-C)
Food / Groceries / Clothing:
Property Rental:
Water / Electricity / Rates / Levies:
Security:
School Fees:
Short Term Insurance:
Vehicle Insurance:
Life Insurance:
Child Maintenance:
Fuel/Transport:
Medical Costs:
Telephone & Internet:
Legal Accounts (excluded from Debt Review):
Other:
Total Expenses:
Amount Available For Debt Review (Nett Salary-C):
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