Debt Relief Application

Authorisation to Conduct a Credit Check*

I agree to the terms below

I hereby give consent to Randbond / Debt Guides (PTY) LTD, to obtain my Credit Records from any Registered Bureau or Registers, for the sole purpose of providing me with a structured, obligation-free Debt Relief Plan.

Name*

First Middle Last

Id Number*

Contact Number*

Email*

Address*

Street Address Address Line 2 City State / Province / Region Postal code

Gross Salary*

Accounts in Arrears*

Consent*

I hereby, agree to Randbond's Privacy and POPIA policies

With reference to the following: POPIA