I declare as follows:

1) I undertake to comply with all requests from the debt counsellor to assist him/her to evaluate my state of indebtedness and to investigate the prospects for responsible debt restructuring. I consent to National Debt Restructure obtaining my credit record from any/all registered credit bureaus and any other registers which may contain any of my credit information.
2) I undertake not to enter into any further credit agreements other than a consolidation agreement, with any credit provider until one of the following events have occurred:
The Debt Counsellor rejects my application; or
The Court determines that I am not over indebted; or
All my obligations under credit agreements as re-arranged are fulfilled.
3) I understand that I MUST NOT SIGN ANY DOCUMENTS whatsoever that I receive from any credit provider and shall make no promises, either verbally or in writing, to any of my credit providers.
4) I undertake not to hand over any of my assets to debt collectors unless I have first discussed the matter with
5) I confirm that the information contained in this document is to the best of my knowledge true and correct.
6) I declare that the debt review process has been explained to me and I understand that:
The debt remains my responsibility and that I must continue making payments to all my credit providers every month notwithstanding the fact that I have applied for debt review. Accounts from service providers and accounts in which legal action has commenced cannot form part of the debt review process and that I am personally responsible for paying them.
I must open a new banking account (savings) and I must arrange for my salary to be paid into the new account. I understand that if I fail to do so, the banks may deduct monies from my account and will not be able to assist in obtaining a refund of monies taken.
I must provide proof of insurance on motor vehicle(s).
The initial repayment amount calculated by may not be sufficient for my credit providers and they may request a higher amount.
therefore, contact me with a request for an increase in the repayment amount.
I understand and accept the Debt Counselling Fee Structure and understand that my first installment of the debt re-arrangement plan (or part thereof) will be payable to for services rendered.
I understand my debt review application must be finalized with a court order and I authorize to instruct an attorney to appear in court on my behalf and I accept full responsibility for the settlement of the legal fees as set out below.
I understand that if I default on any obligation in terms of the debt re-arrangement plan agreed upon with credit providers, such credit providers may terminate the debt review process and then enforce, by litigation or other judicial process, any right or security they may have under my credit agreements. I also understand that may withdraw from my debt review in the event that I default on payments or fail to comply with any reasonable requests.
I understand that I will then be required to pay the original installments and interest rates; reduced installments and interest rates will be cancelled and credit providers can then proceed with legal action against me that may result in judgment being taken and repossession of my assets.
7) I understand that a clearance certificate will only be issued after is satisfied that I have fulfilled all debt obligations under debt review.
8) I understand that there is a duty on me to inform of any changes in my residential address, telephone numbers, employer and income.
9) I indemnify all employees and nominees of against any claim that may be instituted against it or them arising from any act or omission by such person appointed by or its nominee in the lawful execution of the terms and conditions of this agreement entered into by myself, and confirm that shall not be liable for any damages suffered by me resulting from any act or omission of whatsoever nature, however arising. I hereby acknowledge that all lawful
actions taken by under its powers under this agreement are tacitly ratified by me, and I will be bound by such agreements as principal debtor.

Debt Counselling Fee Structure

All fees are regulated by the National Credit Regulator (NCR). We subscribe to the fee guidelines as prescribed by the NCR. Fees payable are as follows (all amounts and percentages quoted exclude VAT):
I declare as follows:
1) I undertake to comply with all requests from the debt counsellor to assist him/her to evaluate my state of indebtedness and to investigate the prospects for responsible debt restructuring. I consent to National Debt Restructure obtaining my credit record from any/all registered credit bureaus and any other registers which may contain any of my credit information.
2) I undertake not to enter into any further credit agreements other than a consolidation agreement, with any credit provider until one of the following events have occurred:
The Debt Counsellor rejects my application; or
The Court determines that I am not over indebted; or
All my obligations under credit agreements as re-arranged are fulfilled.
3) I understand that I MUST NOT SIGN ANY DOCUMENTS whatsoever that I receive from any credit provider and shall make no promises, either verbally or in writing, to any of my credit providers.
4) I undertake not to hand over any of my assets to debt collectors unless I have first discussed the matter with
5) I confirm that the information contained in this document is to the best of my knowledge true and correct.
6) I declare that the debt review process has been explained to me and I understand that:
The debt remains my responsibility and that I must continue making payments to all my credit providers every month notwithstanding the fact that I have applied for debt review. Accounts from service providers and accounts in which legal action has commenced cannot form part of the debt review process and that I am personally responsible for paying them.
I must open a new banking account (savings) and I must arrange for my salary to be paid into the new account. I understand that if I fail to do so, the banks may deduct monies from my account and will not be able to assist in obtaining a refund of monies taken.
I must provide proof of insurance on motor vehicle(s).
The initial repayment amount calculated by may not be sufficient for my credit providers and they may request a higher amount.
therefore, contact me with a request for an increase in the repayment amount.
I understand and accept the Debt Counselling Fee Structure and understand that my first installment of the debt re-arrangement plan (or part thereof) will be payable to for services rendered.
I understand my debt review application must be finalized with a court order and I authorize to instruct an attorney to appear in court on my behalf and I accept full responsibility for the settlement of the legal fees as set out below, the legal fee will be part of your monthly payment to the NPDA on the second month and the third month.
I understand that if I default on any obligation in terms of the debt re-arrangement plan agreed upon with credit providers, such credit providers may terminate the debt review process and then enforce, by litigation or other judicial process, any right or security they may have under my credit agreements. I also understand that may withdraw from my debt review in the event that I default on payments or fail to comply with any reasonable requests.
I understand that I will then be required to pay the original installments and interest rates; reduced installments and interest rates will be cancelled and credit providers can then proceed with legal action against me that may result in judgment being taken and repossession of my assets.
7) I understand that a clearance certificate will only be issued after is satisfied that I have fulfilled all debt obligations under debt review.
8) I understand that there is a duty on me to inform of any changes in my residential address, telephone numbers, employer and income.
9) I indemnify all employees and nominees of against any claim that may be instituted against it or them arising from any act or omission by such person appointed by or its nominee in the lawful execution of the terms and conditions of this agreement entered into by myself, and confirm that shall not be liable for any damages suffered by me resulting from any act or omission of whatsoever nature, however arising. I hereby acknowledge that all lawful
actions taken by under its powers under this agreement are tacitly ratified by me, and I will be bound by such agreements as principal debtor.

Please go back to the application form to accept these Terms and Conditions.