Debt Masters

Debt Review Application

(form 16)

view our POPI and PRIVACY Policies.

Title

first names

last name

id number

passport number

gender

Ethnic Group

Marital Status

language preference

email address

phone (mobile)

phone (home)

residential address

residential postal code

postal address

postal code

name of employer

job title

phone (work)

Employer address

Employer postal code

Number of dependents

Dependent 1 - Name and Surname

Dependent 1 - Age

Dependent 1 - Relation to Applicant

Dependent 1 - ID Number

Dependent 2 - Name and Surname

Dependent 2 - Age

Dependent 2 - Relation to Applicant

Dependent 2 - ID Number

Dependent 3 - Name and Surname

Dependent 3 - Age

Dependent 3 - Relation to Applicant

Dependent 3 - ID Number

Dependent 4 - Name and Surname

Dependent 4 - Age

Dependent 4 - Relation to Applicant

Dependent 4 - ID Number

With whom do your school going children stay after school?

Please provide monthly figures in South African Rand

#1 Gross Salary Income

#2 Commission (6-Month Average)

#3 Overtime (6-Month Average)

#4 Rental Income

#5 Child Maintenance Income

Please provide monthly figures in South African Rand

#11 PAYE

#12 UIF

#13 Pension / Provident Fund

#14 Medical Aid

#15 Garnishee Orders

#16 Staff Loans

#17 Other Salary Deductions

Please provide monthly figures in South African Rand

#25 Food / Groceries / Clothing

#26 Property Rental

#27 Water / Electricity / Rates / Levies

#28 Security

#29 School Fees

#30 Short Term Insurance

#31 Vehicle Insurance

#32 Life Insurance

#33 Fuel / Transport

#34 Child Maintenance

#35 Medical Costs

#36 Telephone & Internet

#37 Other Living Expenses

You must email copies of all outstanding balances due

Creditor 1 - Name of Creditor

Creditor 1 - Account Type

Creditor 1 - Account Number

Creditor 1 - Current Outstanding Balance

Creditor 1 - Current Monthly Instalment

Creditor 2 - Name of Creditor

Creditor 2 - Account Type

Creditor 2 - Account Number

Creditor 2 - Current Outstanding Balance

Creditor 2 - Current Monthly Instalment

Creditor 3 - Name of Creditor

Creditor 3 - Account Type

Creditor 3 - Account Number

Creditor 3 - Current Outstanding Balance

Creditor 3 - Current Monthly Instalment

Creditor 4 - Name of Creditor

Creditor 4 - Account Type

Creditor 4 - Account Number

Creditor 4 - Current Outstanding Balance

Creditor 4 - Current Monthly Instalment

Creditor 5 - Name of Creditor

Creditor 5 - Account Type

Creditor 5 - Account Number

Creditor 5 - Current Outstanding Balance

Creditor 5 - Current Monthly Instalment

Creditor 6 - Name of Creditor

Creditor 6 - Account Type

Creditor 6 - Account Number

Creditor 6 - Current Outstanding Balance

Creditor 6 - Current Monthly Instalment

Creditor 7 - Name of Creditor

Creditor 7 - Account Type

Creditor 7 - Account Number

Creditor 7 - Current Outstanding Balance

Creditor 7 - Current Monthly Instalment

Creditor 8 - Name of Creditor

Creditor 8 - Account Type

Creditor 8 - Account Number

Creditor 8 - Current Outstanding Balance

Creditor 8 - Current Monthly Instalment

Creditor 9 - Name of Creditor

Creditor 9 - Account Type

Creditor 9 - Account Number

Creditor 9 - Current Outstanding Balance

Creditor 9 - Current Monthly Instalment

Creditor 10 - Name of Creditor

Creditor 10 - Account Type

Creditor 10 - Account Number

Creditor 10 - Current Outstanding Balance

Creditor 10 - Current Monthly Instalment

complete only if applicable

Have you previously been under debt review?

If YES, please provide details of your previous Debt Counsellor

Reasons for leaving previous Debt Counsellor

Was a court order granted?

please provide a short description of the reasons for your over-indebtedness

Compulsory section if Single Application OR Married out of Community of Property with Antenuptial Contract

Is your spouse employed?

If your spouse is employed, what amount does your spouse contribute to the monthly expenses?

compulsory if married in community of property (cop) or african traditional

Title

first names

last name

id number

passport number

gender

compulsory if married in community of property (cop) or african traditional

email address

phone (mobile)

phone (work)

compulsory if married in community of property (cop) or african traditional

name of employer

job title

Employer address

Employer postal code

compulsory if married in community of property (cop) or african traditional

#6 Gross Salary Income

#7 Commission (6-Month Average)

#8 Overtime (6-Month Average)

#9 Rental Income

#10 Child Maintenance Income

compulsory if married in community of property (cop) or african traditional

#18 PAYE

#19 UIF

#20 Pension / Provident Fund

#21 Medical Aid

#22 Garnishee Orders

#23 Staff Loans

#24 Other Salary Deductions

compulsory if married in community of property (cop) or african traditional

#38 Food / Groceries / Clothing

#39 Property Rental

#40 Water / Electricity / Rates / Levies

#41 Security

#42 School Fees

#43 Short Term Insurance

#44 Vehicle Insurance

#45 Life Insurance

#46 Fuel / Transport

#47 Child Maintenance

#48 Medical Costs

#49 Telephone & Internet

#50 Other Living Expenses

compulsory if married in community of property (cop) or african traditional

please upload (for applicant) : certified id / passport *

Browse Format required (PDF) - No file selected yet

please upload (for applicant) : Most Recent Salary Payslip *

Browse Format required (PDF) - No file selected yet

please upload (for applicant) : All Creditor Balance Statements *

Browse Format required (PDF) - No file selected yet

compulsory if married in community of property (cop) or african traditional / for joint applications

please upload (For Spouse - Only if applicable) : certified id / passport

Browse Format required (PDF) - No file selected yet

please upload (For Spouse - Only if applicable) : Most Recent salary payslip

Browse Format required (PDF) - No file selected yet

please upload (for applicant) : All Creditor Balance Statements *

Browse Format required (PDF) - No file selected yet

I hereby confirm that all personal details provided are correct and true * I hereby confirm that I would like to apply for Debt Review * I hereby undertake to email my ID (Certified), Recent Salary Payslip and all creditor balances to Debt Masters within 24 Hours (forms @debtmasters .net) * I hereby consent to Debt Masters obtaining my credit report from a registered credit bureau * I hereby request my personal details to be kept confidential in terms of Debt Master's POPI and PRIVACY policies *