Fin Money Debt Solution Specialist
Application form 16 joint
Name and Surname 1st Applicant
Identity Number 1st Applicant
Nett Salary 1st Applicant
Salary date 1st Applicant
Cell Number 1st Applicant
1st Applicant Email
Name and Surname 2nd Applicant
Identity Number 2nd Applicant
Nett Salary 2nd Applicant
Salary date 2nd Applicant
Salary Frequency 2nd Applicant
Cell Number 2nd Applicant
2nd Applicant email
By signing and submitting this electronic application I/we hereby confirm the following and acknowledge.
I/ we have read and accept the terms and conditions of this application.I/we also hereby give consent to do a credit check.I Fully understand and acknowledge that my signature below will populate onto every page
Signature 1st Applicant
Signature 2nd Applicant
Name of account holder to be debited
Type of Account
Debit order date
Very Important:(Debit Order Mandate)
Please ensure that there are always funds available in your account and that we have the correct bank account details. If you change to a new bank account, ensure we have the new details. If and when a debit order is unsuccessful due to no funds or a dispute this must be rectified within 10 days, as this is construed as a breach of contract and legal action can be implemented to recover any and all outstanding fees. Please also take note should a creditor not get their revised payment they may also terminate your application and commence legal action.
This signed Authority and Electronic Debit Mandate refers to our contract,
form16 (" The Agreement ")
1.I/We hereby authorise you to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement.
2.I/We shall not be entitled to any refund of amounts which was withdrawn while this authority was in force, if such amounts were legally owing to you.
3.I/We acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally.
4.I/We agree that although this Authority and Electronic Debit Mandate may be cancelled by me/us. Such cancellation will not cancel my Agreement.
Notice of cancellation of this mandate must be done in writing 21 days prior to next deduction.
5.I/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.
6.I acknowledge that should I/we dispute this debit transaction, legal action can commence against me/us
1. The reference which will appear on the client’s statement will be NPFINMONEY.
2. All Debit order forms must be provided in 5 working days before first deduction.
3. I agree to pay any bank charges relating to this debit order instruction 4. I understand my monthly payment may increase, this my debt counsellor will discuss with me.
5. Electronic debits will be deducted as per selection above I.T.O. date, amount, and type of debit and deduction intervals.
DECLARATION BY THE CONSUMER/S
I/We declare as follows:
1.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.
2.I/We hereby consent to the submission of my/our information to all registered credit bureaus by the debt counsellor.
3.I/We confirm that this is not a loan application, but an application for debt review.(Restructuring of our debt) 4.I/We also consent that the debt counsellor may obtain my/our credit record from any/all registered credit bureaus and any other registers which may contain any of my/our 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 has 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 agreements as re-arranged are fulfilled 6.I understand that I must not sign any documents whatsoever that I receive from my credit providers, and shall make no promises, either verbally or in writing, to any of my credit providers.
7. I/We confirm that the information obtained in this document is, to the best of my/our knowledge, true and correct.
7.2 I/We the undersigned consumer/s hereby agree and undertake to keep the Debt Counsellor indemnified against all loss or damage from any cause arising which I/we may sustain as a result of the application in terms of Section 86 of the National Credit Act 34 of 2005.
8.I/We confirm my instructions to the Debt Counsellor to investigate reckless credit in respect of all my credit agreements and to furthermore instruct the Debt Counsellor to seek a declaration of reckless credit on my behalf should reckless credit be evident.
9.I/We also acknowledge that we cannot hold the Dc responsible should a debit order from a creditor be deducted from our account, we agree to comply with the Dc’s request to cancel the debit orders.
10.I/we hereby confirm that the Debt Review Process and Debt Counselling Fee Structure is understood and accepted.
11.Furthermore I/we undertake to make the interim payments as reflected in the Payment Schedule pending the finalisation of the Consent or Court Order and that failure to do so can result in the termination of the Debt Review application by the Debt Counsellor or Credit Providers.
12.I hereby confirm that by signing this declaration, I enter into a mandate agreement with the debt counsellor willingly, in terms whereof the Debt counsellor has the power to terminate this mandate for default on my part. I hereby confirm that I understand that the National Credit Act does not provide for termination by a debt counsellor, but that mandate agreements such as these are regulated by common law principles and that I accept this mandate agreement in terms thereof.
13. A Consumer who has applied for Debt Review can withdraw from Debt Review only before the recommendation of over-indebtedness (Form 17.2) has been issued by the Debt Counsellor. After the recommendation of over-indebtedness (Form 17.2), a Consumer can only withdraw from Debt Review after the Form 17.W application has been granted by the Court, a Consumer who has been issued with a Clearance Certificate or where a Court Order has been obtained indicating that the Consumer is no longer over-indebted and no longer under Debt Review . A consumer who withdraws from Debt review will be liable for these fees to be paid. Fees for cancellation will be the Dc fee as well as a Legal fee to either rescind order or approach court for credit profile update.
14. I/we hereby choose as my/our domicile citandi et executandi (legal address for all notices) for the purposes of giving notice, the serving of any process and for any purpose arising from this agreement.
15. I/we hereby agree to pay all legal costs and expenses of whatsoever nature on an Attorney and Client basis including collection commission, tracing agent charges, letter of demand costs or any other disbursements incurred by the Debt Counsellor employed by in the event that the Professional Fee, the after-care fee or the Legal Fee is not paid by me/us and action is instituted against me/us.
16. I/we agree that the amount owing to in terms of this agreement at any time shall be determined and proved by a certificate signed by any one of the Company`s authorized representatives whose appointment, qualification and authority need not be proved . I/we irrevocably waive and abandon any right to call upon the Company in any litigation or other proceedings to furnish security for costs.
DEBT COUNSELLING FEES DISCLOSURE
The Debt Counsellor may receive the following amounts in respect of consumers who have applied for debt counselling:
1) An application fee (R50.00) limited to the amount prescribed in terms of Schedule 2(2) of the Act, recoverable directly from the Consumer upon receiving an application for debt review.
2) A Administration fee of R300 (excluding VAT), per Debt Counselling application.
3) A Restructuring fee of the lesser of the revised instalment of the debt
re- arrangement plan and the maximum of R8000.00 (excl. Vat) in respect of a consumer whose applications have been accepted in terms of Section 86(7)(b) or Section 86(7)(c). In the event of a joint application, the fee may be increased to R9000.00.
4) Reckless lending applications R1500.00 per debt counselling application
4.1) Should a Debt Counsellor fail to submit proposals to Credit Providers or refer the matter to a Tribunal or a Magistrates Court within 60 days from the date of the debt review application, the Debt Counsellor has to refund 100% of the fee paid by the Consumer (excluding the application fee)
5) A monthly care fee of 5% (excl. Vat) of the monthly instalment of the debt re - arrangement plan, up to a maximum of R450.00
5.1.) Payment of the monthly after-care fee is to commence after the 2nd month .
6) Should a consumer withdraw from the process after determination has been done (17.2) the restructuring fee is payable. As well as a legal fee to approach court to update credit profile.
7) A legal fee for a consent order of R 500.00. The legal fee for the consent order may only be deducted in the 2nd month after the amount in 3 above has been paid.
7.1) Legal fee for notice and set down is equal to restructuring fee with a minimum of R3000.00 if there are any additional costs for further legal processes, this will be separately negotiated with the client.
I hereby acknowledge:
I fully understand the above mentioned fee structure, and I understand the implications thereof. I also acknowledge and understand that I will be liable for payment of the fees as set out here above. I understand that I am applying for debt review as part of the Debt Counselling process. I fully understand this process I, the undersigned, acknowledge that all details provided above is according to my knowledge true and correct. I understand that I cannot hold the DC liable should the information as supplied by me be incorrect. All account information will be updated when and if a certificate of balance gets issued by the credit providers. . I have read above and fully understand and agree.
MANDATE AND POWER OF ATTORNEY
Agreement of mandate entered into by and between:
SEAN TREVOR NICHOLAS NCRDC 2445
(Here-in after referred to as “The Debt Counsellor (DC)”
(Here-in after to referred to as “The Client”)
Whereas the Client has indicated that he/she is not able to maintain his/her full monthly obligations to his/her creditors; and whereas the Client has requested that the DC act on his/her behalf with regards to the client’s creditors; wherefore the Client hereby grants to the DC a mandate to inter
1.To obtain any records from the Client, his/her creditors and / or credit bureau to assist with the compilation of a schedule of payment and determining a budget.
2.Have a payment schedule drawn for the creditors.
3.Make an offer of payment to the creditors in accordance with the said schedule – and any amendments thereof in the total discretion of the attorneys.
4.That the DC will at all times ensure the well-being of the Client’s financial affairs in as far as this mandate is concerned; including all that is reasonably and legally necessary to assist the Client in relieving and / or settling his / her debt to a creditor(s).
5.To assist with the cancellation of debit orders on behalf of client.
6.Will enter into negotiation with creditors on the Client’s behalf, including litigation with a creditor where it is necessary, also opposing of any collection proceedings that a creditor may institute against the Client.
Transfer Request Form:
Hereby request to be transferred to Debt counsellor (Sean Trevor Nicholas NCRDC2445)
By requesting this transfer I agree and grant Sean Nicholas Special Power of Attorney to:
1. Request a transfer from my current debt counsellor
2. Notify the National Credit Regulator of the transfer;
3. Notify all my creditors of the transfer; and
4. Refer my debt counselling matter to the relevant court with jurisdiction and to apply for an order on my behalf in the event that there is no court order in place.
- I further confirm that Sean Trevor Nicholas and/or Fin Money will not be held responsible in the event that he/they are unable to negotiate a reinstatement of any previously terminated accounts from debt review.
- I understand that if debt counselling is not a viable debt solution for me that Fin Money will cancel the debt counselling agreement by sending out a From 17.2 rejection notice and retain the restructuring fee (as per the NCR guidelines).
The new Debt Counsellor details are as follows:
Dc name: Sean Trevor Nicholas
Dc No: NCRDC2445
Telephone number: 084 397 0724 Email:firstname.lastname@example.org
I confirm that all the information herein contained are true and correct and that I have read and understood the terms and conditions of this agreement.
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