Debt Away-Aplication Form

Debt Away

We need the following information from you:

Your ID book and a copy of the front page.
Copies and schedule of balances owing to all credit providers with copies of their statements of balance, account numbers and interest rate if possible
Your salary slip and details of any other income you and/or members of your household may have.
Details of your monthly expenses(excluding payments to your credit providers)
Copies of any credit agreements to check for reckless lending or illegal contracts or portions thereof.(credit providers are legally required to issue you with a single replacement copy of a document free of charge if so requested within one year after the date for the original delivery of the document.Thereafter they are permitted to charge search and production fees permitted by regulation)

You can attach the required documnets to your application online.

E-mail Address: *
Full Name *
Surname *
Identity Number *
Physical Address *
Time At Address since *
Marital Status
If married how
Telephone Number (Work) *
Telephone Number (Home)
Cell Phone Number *
Name of Employer *
Address of Employer *
Occupation *
Time with Employer since *
No. Of Dependants *
Gross Salary/Pension *
Deductions: Tax *
Medical Aid *
Pension *
Other Deductions (Specify)
Net Salary/Pension *
Monthly Expense: Food *
Property Rental
Municipal Rates (where property owned)
Utilities (i.e electricity, water)
Transport (where essential for work)
Medical expenses
School fees
Telephone
Clothing
Insurance premiums
Other essential living expenses
Debt Obligations *
Name of Creditor
Total amount Outstanding *
Monthly Commitment *
Account Number *
Name of Creditor
Total amount Outstanding
Monthly Commitment
Account Number
Name of Creditor
Total amount Outstanding
Monthly Commitment
Account Number
Name of Creditor
Total amount Outstanding
Monthly Commitment
Account Number
Name of Creditor
Total amount Outstanding
Monthly Commitment
Account Number
Name of Creditor
Total amount Outstanding
Monthly Commitment
Account Number
Referred by
Attach a File:Upload your documents HERE


* Required