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I/ we declare as follows:
1. Do hereby acknowledge that I am currently unable to meet my monthly commitments to my credit providers and have applied for debt review.

2. The process of the debt review and the role of the debt counsellor has been fully explained to me and is clearly understood by me. I understand that that whilst under debt review and during the debt restructuring plan, I am unable to incur any further debt.

3. I hereby instruct the debt counsellor to take whatever legal steps he/she may deem necessary to improve my ability to meet my financial monthly commitments. It is understood that once the matter is handed over to the Magistrate's Court the final decision is that of the magistrate and the debt counsellor cannot be held liable for the decision the magistrate makes.

4. It is understood that the debt counsellor will include the following credit agreements in the review Home loans, Vehicle Finance, Credit & Store cards, Personal Loans, Overdrafts and Microloans.

5. National Credit Revolution and NCRDebtCounsellor.co.za has the following powers, for the purposes mentioned above:
a) To obtain & disclose information regarding my financial position to/from credit providers.
b) To negotiate a debt restructuring plan with my credit providers.
c) To cancel any authority given by me to my credit providers prior to this agreement.
d) To apply to the magistrate court for a consent order according to the debt restructuring plan.
e) Not to conclude an agreement with my credit providers which may unfairly prejudice my rights

6. I agree to pay National Credit Revolution and NCRDebtCounsellor.co.za the fees as explained to me and which are calculated as:
a) Once off application fee of R50 plus additional R80 for a credit report if I cannot obtain one myself.
b) A fee of 100% of my first monthly debt rearrangement up a maximum of R 6000 for a single application.
c) A fee of 100% of my first monthly debt rearrangement up a maximum of R 6000 for a double application.
e) If I withdraw from the debt review process prior to submission of proposals 50% of the restructure fee is refundable.
f) If I withdraw from the debt review process after the re-arrangement plan is completed 25% of the fee is refundable.
g) A monthly rehab fee of 5% deducted from the restructured amount, reduced to 3% after 2 years
h) Legal fees: If all credit providers agree then a consent order is required at R 750.00. If no agreement is reached then
the matter is referred to a magistrate court who will make the final decision as per the National Credit Act - the cost may escalate. This will however first be confirmed with the consumer. In order for there not to be an issue in the future we
request the amount to be paid directly in to DC Partner's (A NCR Registered Payment Distribution Agency) nominated bank account and if a consent order is received
then the balance will be refunded.

7. I understand that National Credit Revolution and NCRDebtCounsellor.co.za utilizes DC Partner to distribute the restructured payment to the credit providers. I understand the fee associated to distribute the funds is as follows:

a) Payments of R0 - R199 = R7 + vat
b) Payments of R200 - R499 = R15 + vat
c) Payments of R500+ = R25 + vat

8. In the event I require a consent order, I agree that the jurisdiction for all my credit agreements be transferred to the Magistrates jurisdiction of National Credit Revolution and NCRDebtCounsellor.co.za. The jurisdiction being Bloemfontein.

9. I acknowledge that whilst under debt review with National Credit Revolution and NCRDebtCounsellor.co.za, I will not engage the services of any other debt counsellor or debt assistance entity.

10. In the event that I do not punctually pay any of my monthly payments to the Distribution agency in terms of my debt plan, National Credit Revolution and NCRDebtCounsellor.co.za shall be entitled to terminate this agreement and decline to further act for me, which will have the result that my credit providers will collect all amounts due to them as they deem fit.

11. I hereby acknowledge that all lawful actions taken by National Credit Revolution and NCRDebtCounsellor.co.za under it's power under this Power of Attorney are tacitly ratified by me and I will be bound by such agreements as principal debtor.

12. I undertake to comply with all requests from the debt counsellor and to assist him/her to evaluate my state of indebtedness and the prospect s for responsible debt restructuring.

13. I hereby consent to the submission of my information to all registered credit bureaus by the debt counsellor.

14. I also consent that the debt counsellor may obtain my credit record from any/ all registered credit bureaus and any other registers which may contain any of my credit information.

15. I undertake not to enter into any further credit agreements, other than a consolidated agreement with any credit provider until one of the following has occurred:

a) The debt counsellor rejects my application.
b) The court determines that I am not over-indebted or
c) All my obligations under credit agreement as re-arranged are fulfilled.

16. I confirm that the information contained in this document is, to the best of my knowledge true and current.