DEBT RELIEF MEASURES

DEBT ELIEF MEASUES Our MISSION is to commit ourselves to be qualified for the service we shall render and to, at the best of our abilities, render professional reliable service at all times. TAKE NOTE 1. We can only be of assistance to you if you trust us and complete documentation accurately. It is your responsibility to provide us with COECT and HONEST information. Please do not leave out or omit anything. 2. We MUST HAVE your correct contact details at all times, please ensure that we have your correct cell phone- or phone number and postal address. 3. A consultant will explain the debt relief measures to you. Please be sure that you understand all the consequences, fees, etc. before you sign any documentation. NEVE SIGN ANY DOCUMENT YOU DO NOT UNDESTAND!! BE ESPONSIBLE GET OUT OF DEBT!!! Thank You On behalf of all the Debt Counsellors at Debt Associates

APPLICATION FOM (FOM 16) A. 1. PESONAL INFOMATION (Yourself) Surname: Maiden Surname: (if applicable) Full names: Id number: Tel. nr :( W) (H) (C) Fax: Email: Physical Address: Postal Address: Employer: Physical Address Employer: Employer No: Occupation: Marital Status: (Please state in community, out of community with accrual or out of community without accrual) 2. PESONAL INFOMATION (Your Spouse) Surname: Maiden Surname: (if applicable) Full names: Id number: Tel. nr :( W) (H) (C) E-mail address: Physical Address: Postal Address: Employer: Physical Address Employer: Occupation: 3. DEBT EVIEW HISTOY Have you ever been under debt review before: YES / NO If yes, please provide detail:

4. PESONAL INFOMATION (Your Dependents) Name Age elationship B. FINANCIAL INFOMATION 1. YOU INCOME (Attach your pay slip!) Gross Income (Before deductions) Any other (specify example maintenance, rent from property etc.) TOTAL INCOME 1.1 DEDUCTIONS (As on your pay slip) Tax Medical Aid Pension/Provident Fund Other deductions (Specify) TOTAL DEDUCTIONS NETT INCOME: 2. YOU SPOUSE S INCOME (Attach pay slip of spouse) Gross Income (Before deductions) Any other (specify example maintenance, rent from property etc.) TOTAL INCOME

2.1 DEDUCTIONS SPOUSE (As on your pay slip) Tax Medical Aid Pension/Provident Fund Other deductions (Specify) TOTAL DEDUCTIONS NETT INCOME SPOUSE: 3. COMMITMENTS: (Please indicate what amount you use for the following?) Groceries Transport (Petrol) ent Water & Lights ates & Taxes/Levies School Fees Medical Aid Maintenance Policies Insurances Cell Phone Utilities Other (Specify) TOTAL COMMITMENTS

PLEASE TAKE NOTE THAT YOU DEBTS WILL NOT BE LISTED ABOVE BY OTHE, ONLY IN THE BELOW MENTIONED TABLE. CEDITO INFOMATION (all debt must be filled in including furniture & property) attach statements of each debt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Creditor/Attorney Name eference Outstanding Amount TOTAL Monthly Payment (a) O/INDEBTED BY: (b) SOON TO BE: (c) NOT O/INDEBTED

FIXED ASSETS BOND APPOXIMATE VALUE MOVEABLE ASSETS CEDIT AGEEMENT APPOXIMATE VALUE PAYMENT BY PDA (Payment Distribution Agency) The PDA is accredited by the NC as a Payment Distribution Agent. The PDA appointed by your Debt Counsellor will make the payments to your credit providers. The contract will be presented to you by your Debt Counsellor. Please ensure that you understand all costs explained. Signature:

I/We am/are the Applicant(s) herein. (1) I/We am/are unable to meet my/our financial obligations and therefore am/are overindebted. (2) I/We undertake to comply with all requests from the Debt Counsellor to assist him/her to evaluate my/our state of indebtedness and the prospects for responsible debt restructuring; (3) I/We hereby consent to the submission of my/our information to all registered credit bureaus by the Debt Counsellor; (4) I/We also consent that the Debt Counsellor may obtain my/our credit record for any/all registered credit bureaus and any other registers which may contain any of my credit information; (5) I/We undertake not to enter into any further credit agreements, other than a consolidated agreement, with any credit provider until one of the following events have occurred: a. The Debt Counsellor rejects my/our application; b. The court determines that I/we am/are not over-indebted; or c. All my/our obligations under credit agreement as re-arranged are fulfilled; (6) I/We confirm that the information contained in this document is, to the best of my/our knowledge, true and correct. I/we the undersigned hereby consent to my/our address and contact numbers being placed on the Form 17.1 which is distributed to the credit providers and the credit bureaus. Signed at on this day of 20 1 st Consumer 2 nd Consumer I, _, consultant for Awie Coetzee Debt Counsellor, NCDC418 declare that all debt relief measures were explained to the consumer in an understandable language. All costs involved were explained and signed for. Consultant Id:

I/ We, the undersigned confirm that the Debt Counsellor informed me of the following and we understand that: (1) My application for Debt eview DOES NOT stop my liability for payment of my accounts. (2) The Debt Counsellor deals with the Debt eview Centre of the creditor providers and all documentation is sent to them. This means that the local branches may still phone me and I will have to refer them back to their respective Debt eview Centre, or to the offices of Consolidated Debt Counsellors. I will also further receive automated sms s from the credit providers. (3) With reference to item (3) above, I may not enter into negotiations with my creditors myself or sign any documentation which was not approved by the Debt Counsellor, no matter how much threatening messages or telephone calls I receive. (I will report threatening messages and telephone calls from credit providers to my Debt Counsellor with immediate effect.) (4) Once I have applied for Debt eview, I may NOT under any circumstances use my credit cards or buy on my accounts. If I do so, my creditors will cancel my Debt eview. (5) I was advised to open a new bank account at any bank of my choice, specifically a savings account, and arrange for my salary to be paid into that account. The details of the account must then be submitted in writing to my Debt Counsellor for completion of the PDA contract. (6) I was advised that a cheque account with an overdraft facility will automatically closed by the bank, which may cause a situation in which I will not have access to any available monies, even if it is a salary payment. (7) If I insist on using my current bank account, it is my responsibility to ensure that all my debit orders (excluding items listed under expenses, e.g. insurance, policies, etc.) are cancelled, to ensure that the PDA may deduct the correct amount. (8) It is not the duty of my Debt Counsellor to negotiate repayment of money deducted from my bank account by means of debit orders which I did not stop or which was authorised due to the fact that I refused to change my bank account. (9) I acknowledge that, although is the appointed Debt Counsellor, the offices of Debt Associates Debt Counsellors function as a whole and will certain aspects of my file be handled by other consultants and I do agree to also co-operate fully with all staff members. (10) That I/we undertake to immediately notify the Debt Counsellor of any change of employment, address and contact numbers or any other information that may change since the date of my application. (11) I agree to submit any outstanding documents requested by the Debt Counsellor on date of application, within 10 working days of date of signature. Failure thereof will result in not being able to obtain a Court date timeously and therefore put you at risk of defaulting to your Credit Providers, which can result in termination of your debt review application. (12) The Debt Counselling and Legal fees were fully explained to me by the Debt Counsellor and I have agreed thereto. Applicant/s Date

NCDC418 Client equirements: 1. 50 Consultation Fee 2. 3 Month bank statements 3. Client & Spouse copy of ID (if married COP) 4. Client & Spouse copy of latest pay slip (if married COP) 5. Latest statements from all creditors 6. Completed form 16 (provided by us) 7. Proof of ent 8. Proof of income from property letted out (lease agreement) 9. Proof of School Fees (eceipt) 10. ates & Taxes account 11. Proof of Policies (if not deducted from salary/bank statement) 12. Proof of Insurance(if not deducted from salary/bank statement) 13. If legal action was taken and order granted by court (proof thereof to be included in monthly expenses) 14. Proof of maintenance 15. Proof of any other income or expense not mentioned above Banking details: A COETZEE STANDAD BANK ek No: 021741247 Branch code: 014637 Your ef: Contact details: (087) 751 2255 (T) 0865418669 (F) Fax to email consultants: Awie: 0865418669

Terms and conditions I/We ID Hereby undertake to conform to the following terms and conditions and understand that failure to comply with any condition as stipulated below may lead to immediate deregistration without further notice. 1. INCOME: All sources of income must be declared. Any additional income received during the debt review term must also be declared in writing within 5 working days of receipt. Failure to comply will lead to immediate deregistration as it amounts to defrauding creditors. 2. ANY EQUEST OF POOF O DOCUMENTATION from the debt counselor must be adhered to within 5 working days from date of application. 3. ALL ACCOUNTS MUST BE DECLAED on the date of application. Non-disclosure of accounts may lead to incurring additional fees and the debt counsellor and his employees will accept no responsibility for any repercussions due to non-disclosure of any account, whether on purpose or accidental. 4. FEES: Once off and ongoing: Fees are payable in full on date agreed on the signed Fee Agreement. Also note that as Debt Associates works on prescribed timelines, 75% of the fee will be due within 5 working days should you decide to cancel the application. Non-payment will result in legal action. The applicant/s do declare that by signing this agreement they are entering into a de facto service agreement and will be liable for any service fees payable, as prescribed, which will run until the debt counsellor issues a clearance certificate upon repayment of the consumer s debt or cancellation in writing from the consumer. Proof of payment must be faxed to 086 541 8645 5. MONTHLY INSTALLMENTS: All installments must be paid to the NPDA on the agreed date. The NCA does not make provision for partial payments or non-payment. Therefore non-payment will lead to deregistration or in creditors terminating the debt review. Proof of payment must be faxed to 086 541 8645. It is specifically recorded that no increased monthly installment shall be deducted from your bank unless you have consented thereto in writing.

6. LEGAL ACTION TAKEN: Any important documents such as summonses or letters from banks must be presented to the debt counselor immediately to effect action. Failure to do so will be for the consumer s own risk. 7. PAYMENTS: The consumer accepts full responsibility for making payments into the correct accounts, using the correct reference numbers and on the stipulated dates. 8. LEGAL FEES & DEBT COUNSELO FEES: These fees were fully explained to me by the Debt Counselor and I have agreed thereto and accept full responsibility thereof. 9. COUT POCEEDINGS: Please note that all debt review matters must currently be heard by a Magistrate and that Magistrate s Court rules will apply to debt counselling proceedings. The presiding Magistrate will enforce the legislation as per their interpretation thereof and interpretations may differ from court to court. It is also important to note that some courts may require the presence of the consumer in court and the consumer must be available should it be required. 10. CALLS FOM CEDITOS WHILST UNDE DEBT EVIEW: Some creditors make use of call centers. It is possible that you will receive calls and/or final demand letters from these creditors for the first 30 days after this application. Should this happen after 30 days have expired, please note the person, reference number, date of call and contact number. Please contact us immediately with this information, so that we can resolve the query. 11. BALANCES & STATEMENTS: The consumer should note that all balance-enquiries during the debt review term should be directed to the creditor in question. Consumers should also still receive their normal statements from creditors and should contact creditors should they not receive statements. 12. UPDATED PESONAL INFOMATION: The consumer undertakes to inform the debt counsellor in writing within 48-hours of any change in address, telephone numbers or employment details. The debt counsellor will not accept any responsibility for any action arising from inability to contact a consumer timeously. The consumer should also note that according to most credit agreements it remains their responsibility to inform a creditor of change in address and that a consumer should retain proof of delivery.

13. UPDATED FINANCIAL INFOMATION: The consumer undertakes to inform the debt counsellor of any material change in their household income whether due to decreased expenses or responsibilities or increased income within a calendar month of such an occurrence. The consumer also consents to an annual revision as prescribed in the regulations and will provide the debt counsellor with the latest income and expense statements on reaching the 13 th month in the debt review process without the debt counsellor having to extend such a request. The consumer undertakes to send such information to the contact numbers and addresses supplied on date of application. The debt counsellor will discuss any proposed changes to the repayment plan within 5 working days of receipt of all relevant documentation. 14. LEGAL STATUS OF ACCOUNTS: The consumer will note that only accounts that are eligible for debt review will and can be included in debt review. Where an account has been excluded the responsibility to make arrangements for such an account will fall to the consumer. The debt counsellor, using his discretion may assist the consumer to make such agreements which fall outside the parameters of debt review. 15. FOM 17.1: Notification of your Debt eview application will be faxed to all your creditors within 5 working days from date of application. These documents will be e- mailed or faxed to you. If a creditor calls you, you have to fax the specific creditors from to them. Inform them that you are under Debt eview and request them to fax a Certificate of Balance to my office. In the case of you not supplying a fax number or email address to the Debt Counselor, it is your responsibility to collect these forms from our offices within 6 working days of application. Please ensure that you understand the debt-review process fully. Your fee of is payable on / /20 (TO BE PAID IN CASH/EFT) Your first installment of is payable on / /20 (AANGE A STOP-ODE)

Fees to be calculated as follows: 1 - FEE = FIST INSTALLMENT TO THE MAXIMUM OF 6840 (VAT INCL) O LESS PE APPLICATION. 2 - DC AFTECAE FEES = 5% OF THE INSTALLMENT ECUING. Signature / /20 I/WE ID hereby declare that the reason for my/our financial predicament is as follows: Special Circumstances: