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PO Box 10215, Empangeni, KwaZulu-Natal, 3880

APPLICATION FORM CREDIT CLEAR

Removal of Default Listings Rescission of Judgement

Fax: 086 293 9173 www.sabizlink.co.za | legal@sabizlink.co.za © 2005 SA Business Link - All rights reserved Company Reg. No - 2005/004233/07

PERSONAL DETAILS TITLE

FIRST FULL NAME

INITIALS

SECOND FULL NAME

SURNAME

GENDER

I.D. NUMBER CODE

FEMALE

MOBILE NO

(Green ID Book)

TEL (W)

MALE

NUMBER

TEL (H)

CODE

NUMBER

FAX NO

CODE

NUMBER

E-MAIL ADDRESS RESIDENTIAL ADDRESS TOWN | SUBURB PROVINCE

RESIDENTIAL POSTAL CODE

POSTAL ADDRESS TOWN | SUBURB PROVINCE

POSTAL CODE

DETAILS OF CREDITORS, DEFAULT PAYMENTS AND JUDGEMENTS 1

DEFAULT PAYMENT

DETAILS OF FIRST CREDITOR

CREDITOR NAME

JUDGEMENT

CONTACT PERSON

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

CASE NUMBER

REFERENCE NO

DEFAULT PAYMENT

DETAILS OF SECOND CREDITOR

CREDITOR NAME

JUDGEMENT

CONTACT PERSON

Tick this box if you are listed by a creditor for slow payments.

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

THE COURT NAME

CONTACT NO

CASE NUMBER

REFERENCE NO

3

slow payments.

THE COURT NAME

CONTACT NO

2

Tick this box if you are listed by a creditor for

DEFAULT PAYMENT

DETAILS OF THIRD CREDITOR

CREDITOR NAME

JUDGEMENT

CONTACT PERSON

Tick this box if you are listed by a creditor for slow payments.

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

THE COURT NAME

CONTACT NO

CASE NUMBER

REFERENCE NO

I hereby confirm that I have read the Terms and Conditions on the reverse side of this form and that I fully understand the contents thereof. DATE OF THIS APPLICATION Day

Month - Spelled out

Year

SIGNATURE: Applicant


DETAILS OF CREDITORS, DEFAULT PAYMENTS AND JUDGEMENTS CONTINUED 4

DETAILS OF FOURTH CREDITOR

CREDITOR NAME

DEFAULT PAYMENT

JUDGEMENT

CONTACT PERSON

DETAILS OF FIFTH CREDITOR

CREDITOR NAME

DEFAULT PAYMENT

JUDGEMENT

CONTACT PERSON

Tick this box if you are listed by a creditor for slow payments.

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

CASE NUMBER

REFERENCE NO

DETAILS OF SIXTH CREDITOR

CREDITOR NAME

DEFAULT PAYMENT

JUDGEMENT

CONTACT PERSON

Tick this box if you are listed by a creditor for slow payments.

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

THE COURT NAME

CONTACT NO

CASE NUMBER

REFERENCE NO

DETAILS OF SEVENTH CREDITOR

CREDITOR NAME

DEFAULT PAYMENT

JUDGEMENT

CONTACT PERSON

Tick this box if you are listed by a creditor for slow payments.

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

THE COURT NAME

CONTACT NO

CASE NUMBER

REFERENCE NO

8

you OR if you have signed a Consent to Judgement (Sec 57)

THE COURT NAME

CONTACT NO

7

Tick this box if a Summons (Sec 65) was issued against

CASE NUMBER

REFERENCE NO

6

slow payments.

THE COURT NAME

CONTACT NO

5

Tick this box if you are listed by a creditor for

DETAILS OF EIGHTH CREDITOR

CREDITOR NAME

DEFAULT PAYMENT

JUDGEMENT

CONTACT PERSON

Tick this box if you are listed by a creditor for slow payments.

Tick this box if a Summons (Sec 65) was issued against you OR if you have signed a Consent to Judgement (Sec 57)

THE COURT NAME

CONTACT NO

CASE NUMBER

REFERENCE NO

TERMS AND CONDITIONS 1. The duration of the rescission and default clearing process is six (6) to eight (8) weeks, depending on the accuracy of the information you have provided. 2. You will receive updates frequently on the progress of your case via E-mail correspondence or sms. Because of our confidentiality conduct and respect for you as our client, we do not discuss your information or the progress of your case telephonically. 3. A quotation will be provided for your approval. Once approved by yourself, payment notification faxed to SA Business Link and the payment reflects in our account the process will start. 4. Please be advised that the clearing of default payments is dependant on the sole discretion of the creditor. If the creditor do not want to clear your record you will forfeit your payment. This however only happens in extreme cases and most of the time the creditors are willing to negotiate the terms and conditions. 5. In dealing with Judgements we provide a service where the Judgement was taken by a Magistrate Court. High Court cases are dealt with separately and other Terms and Conditions apply for such cases. 6. By signing this application you give your consent to the staff member/s of SA Business Link appointed to your case, to obtain your credit profile from the various credit institutions. 7. Please be advised that no refunds will be granted.

THANK YOU FOR YOUR SUPPORT - YOUR CASE REPRESENTATIVE WILL CONTACT YOU SHORTLY!

legal-credit-clear-application  

CREDITOR NAME CREDITOR NAME CONTACT PERSON CONTACT PERSON CONTACT PERSON SECOND FULL NAME CONTACT NO CONTACT NO CONTACT NO DEFAULT PAYMENT D...

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