test InformationPersonal DetailsFull Name(s) *Surname *Cellphone Number *Email Address *Physical Address *Marital StatusMarital StatusMarital Status *SelectSingleMarriedDivorcedWidowedHow are you currently married? *SelectIn community of propertyAntenuptial AgreementTraditionally MarriedDid you apply for Debt Review alone or with your spouse? *SelectI applied for Debt Review aloneI applied for Debt Review with my spouseI am not sureYour ID Number *0 / 13Spouse's Full Name(s) *Spouse's Surname *Spouse's Cellphone Number *Spouse's Email Address *Spouse's ID Number *0 / 13Employment StatusEmployment StatusWhat is your current employment status? *SelectEmployedSelf-EmployedPensionerUnemployedName of organization for which you are employed or self-employed? *What is your current role? *Work Address *What is your spouse's current employment status? *SelectEmployedSelf-EmployedPensionerUnemployedName of organization for which your Spouse is employed or self-employed? *What is your Spouse's current role? *Work Address *DependantsDependantsDo you currently have any dependants? *SelectYesNoDependant InformationDependant's Name *Age *Relation to you *IncomeIncomeYour current monthly Net Income (NB: Net Income is after deductions) *ZARAmount of Other Income (If Applicable)ZAROther IncomeYour Spouse's current monthly Net Income (NB: Net Income is after deductions) *ZARYour Spouse's Amount of Other Income (If Applicable)ZARYour Spouse's Other IncomeHousehold Living ExpensesHousehold Living ExpensesRentZARWater and ElectricityZARMunicipal Rates/LeviesZARHousehold SecurityZARFuel or Travel ExpenditureZARHousehold InsuranceZARVehicle InsuranceZARFuneral Policy (Not deducted from salary)ZARLife Insurance (Not deducted from salary)ZARPension Contribution (Not deducted from salary)ZARGroceriesZARChild MaintenanceZARMedical Aid (not deducted from salary)ZARAdditional Medical ExpensesZARCellphone ExpenditureZARHome InternetZAREducational Fees (Pre-Primary, School or University Fees)ZARBank ChargesZARDomestic HelperZAREntertainment (DSTV, Netflix, etc)ZAROther ExpendituresZARBrief description of Other Expenditures aboveCredit AgreementsCredit AgreementsDo you have any outstanding debts (Home loan, Vehicle finance, Personal Loans, Credit Cards, etc) on your name? *SelectYesNoDoes your Spouse have any outstanding credit agreements (Home loan, Vehicle finance, Personal Loans, Credit Cards, etc) on their name? *SelectYesNoSupporting DocumentsSupporting DocumentsA copy of your IDSize Limit 5MBChoose FileNo file chosenDelete uploaded fileA copy of your Proof of AddressSize Limit 5MBChoose FileNo file chosenDelete uploaded fileA copy of your most recent salary slip(s). Please upload 3 months salary slips if you earn commission or overtime.Size Limit 5MBChoose FileNo file chosenDelete uploaded fileA copy of your 3 months bank statement.Please upload a bank statement which reflects your salary or income stated above.Size Limit 5MBChoose FileNo file chosenDelete uploaded fileA copy of your Spouse's IDSize Limit 5MBChoose FileNo file chosenDelete uploaded fileA copy of your spouse's most recent salary slip(s). Please upload 3 months salary slips if your spouse earns commission or overtime.Size Limit 5MBChoose FileNo file chosenDelete uploaded fileA copy of your spouse's 3 months bank statement.Please upload a bank statement which reflects your spouse's salary or income stated above.Size Limit 5MBChoose FileNo file chosenDelete uploaded fileFee DeclarationFee DeclarationYou have indicated that you currently do not have any active credit agreements on your name. You therefore may qualify for a Clearance Certificate. The applicable fee in this regard is a once-off amount of R1000,00. Please note that should we determine that you still have active credit agreements on your name, we will have to refer your matter to a Magistrates court and the applicable fee will be an amount of R7500,00.Based on the information provided above, the expected total fee for the removal of your Debt Review flag is R1000,00. Should it be necessary to refer your matter to court, the applicable fee will then become R7500,00 In this case, please indicate how you would like to pay the R6000,00 fee (only applicable if we need to refer our matter to court). Please note that you will be advised accordingly via email before any changes to your fees are processed.You have indicated that you (or your spouse where applicable) have active credit agreements on your name. We will therefore need to refer your matter to the Magistrates Court. The applicable fee in this regard is a once-off amount of R7500,00. Please note that the fee stated above may be paid in full once-off or may be divided into 2 or 3 equal monthly payments. We will nonetheless start working on your file immediately upon receipt of your application. Please note that we will only refer your matter to court once the full fees have been pain in full. Please tick the box if you agree to the fees stated above.How would you like to pay the fees above? *Please note that we will make a court application approximately 15 business days after your fees have been paid in fullSelectDebiCheck of R7500.00 once-offDebiCheck of R3750.00 for 2 monthsDebiCheck of R2500.00 for 3 monthsDebiCheck Banking DetailsDebiCheck Banking Details Kindly be advised that national Debt Helpline makes use of DebiCheck to collect applicable fees. You will now be requested to input the banking details from which we may load a DebiCheck mandate accordingly.Banking DetailsBanking Details Kindly note that the banking details below will be used to load a DebiCheck mandate for the fees indicated above.Bank *Account Type *Account Number *Salary Date *Signature TermsKindly note that by placing your signature on the space below you agree to National Debt Helpline’s Terms and Conditions. Furthermore, kindly note that your signature will be used to autopopulate an application form for the removal of your Debt Review flag. A copy of the signed application form will be sent to you via email shortly.Your Signature *Start signing your signature hereYour browser does not support e-Signature field.Spouse's Signature *Start signing your signature hereYour browser does not support e-Signature field.Terms and ConditionsTerms and Conditions 1. This is an application for the removal of debt review. It is not an application for debt review. 2. The infromation provided on this online application will be used to autopopulate an application form for the removal of your debt review flag. You will receive a copy of the application form shortly after submitting the this application. 3. It remains your responsibility to ensure that payment to your creditors is made as agreed. Clear Debt Review will not become responsible for any payment towards your credit providers.Checkbox *I have read and agree to ndhdc.co.za’s Terms and Conditions.Submit