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Form 16

Part 1 - Personal Details

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.


I herewith consent to service of my Debt Review Application and/or all other court document relating to the said debt review application on me by email at:

Ethnic Group

Part 2 - Spouse Details (Compulsory if married in COP or African Traditional)

Not Applicable

Part 3 - Budget Details

 A. Income

 B. Salary Deductions

[ field57 - field78 ]

[ field80 - field56 ]

C. Living Expenses

Part 4 – If Married Out of Community of Property (Antenuptial Contract) and Single Application, please complete the following

Part 5 – Creditor Obligations (please include bank overdrafts)

Part 6 – Previous Debt Review Information

Part 7 – Reason for Over Indebtedness


I hereby declare that the information supplied by myself in the application form is for myself and is true and correct, and includes all my credit agreements. I consent to Debt Rescue obtaining my credit report from a registered credit bureau for the purpose of obtaining my credit agreements to assist in the assessment.*
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