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You must be gainfully employed and earn a minimum of R6,000.00 per month. Stokvels, family loans and shareholder

loans may not be included when calculating the total value of your exsiting debt. Should you meet these criteria,

please complete the application form below and a consultant from United Debt Counsellors will contact you shortly.


Please note: All infomation provided by you is kept strictly confidential and will not be resold or used for any other reason.

 

In which province do you reside? 

What is the combined value of your current Debt? (estimate) 

How much do you pay towards your debt each month? (estimate) 

What is your total monthly household income? (Net) 

Title: 

First Name: 

Last Name: 

Telephone # 

Mobile # 

Email Address: 

Confirm your Email Address: 

Do you own property? 

Preferred Contact Method:

Preferred Contact Time:

 
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