HAASBROEK-WILLEMSE INC - DEBT COUNSELLING

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Welcome to the Haasbroek-Willemse Debt Counselling Instruction Page.

Please follow the following procedure when submitting a new instruction:

• Complete this form and e-mail supporting documents no later than day 30 of the 60 day debt suspension period;
• Payment should be made within 5 days of completing this form;
• You will then receive the draft affidavit within 10 days of date payment was received;
• The original commissioned affidavit should be returned to Haasbroek-Willemse within 5 days;
• You will receive a copy of the issued Notice of Motion within 10 days after having returned the original affidavit to us.

Legal fees can be deposited directly into the following account:

Haasbroek-Willemse Trust
Bank: ABSA
Account no: 1290410025
Ref: MD1002 / (Surname of Consumer)

Pleas forward proof of payment to martus@haaswil.co.za or fax it to (057) 212 9699

For more information, please contact Haasbroek-Willemse Incorporated at (057) 212 5665 or martus@haaswil.co.za

Debt Counsellor's Details

Name of Debt Counselling Company *

Name of Debt Counsellor *

Telephone number of Debt Counsellor *

E-mail address of Debt Counsellor *

Place of Business of Debt Counsellor *

(i.e. physical address)

NCR Number *

First Consumer's Details

First Consumer's Full Names and Surname *

First Consumer's ID Number *

First Consumer's Physical Address *

Postal Address of First Consumer *

Telephone number of First Consumer *

Name of First Consumer's Employer *

(i.e. company name)

Physical Address of First Consumer's Employer *

Second Consumer's Details

(Only when applicable)

Second Consumer's Full Names and Surname

(Where Applicable)

Second Consumer's ID Number

(Where Applicable)

Name of Second Consumer's Employer

(Where Applicable)

Other

Date of Registration on NCR Website *

Date Form 17.1 was sent to creditors *

Date Form 17.2 was sent to creditors *

Proposed Monthly Installment as per Proposal *

Date of first payment to creditors *

Amount payable by Consumer *

Select number of Credit Accounts reflected on Proposal. Fees quoted are VAT inclusive

1-10 (R2 280.00 payable by consumer)

11 + (R2 280.00 + R114.00 payable by consumer for every credit account exceeding 10)

Pensioner special (R570.00 - i.e. less than 6 credit accounts with a total debt of less than R25 000.00)

Documents to be e-mailed to martus@haaswil.co.za *

Tick documents available

Debt Restructuring Proposal

Finanacial Assessment Process

Over Indepted Calculation

Proof of Fax (Form 17.1)

Proof of Fax (Form 17.2)

COB's

Salary Advice / Proof of Income (x 3 months of Consumers)

NCR Certificate

Reason for Over Indebtedness

Form 16, signed by the Consumer(s)

Other:

Required

Date Legal Fees will be paid *

(Debt Counsellor must inform consumer of amount payable)

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