Transfer Consent and POA
1
CONSENT
2
SECTION B
3
POWER OF ATTORNEY
PART 1
Instructions
1. Complete all the sections of the application from
2. Applicant who is married in community of property must submit a joint application with their spouse. The spouse’s details will be completed in the 2nd applicant sections of the application form.
3. Send your application to: The Debt Counselor. WhatsApp 062 086 3083/ mathavhathe@vodamail.co.za/dc@ldcservices.co.za
SECTION A: PERSONAL INFORMATION
Primary Applicant
Full Names
(Required)
First Name
Surname
Upload ID Copy
(Required)
Drop files here or
Select files
Max. file size: 10 MB, Max. files: 5.
Upload a copy of your ID or take a photo of your ID and upload the photo.
Marital Status
(Required)
Single
Married
Divorced
Widowed
Separated
Domestic Partnership
Number of Dependants
(Required)
Tel Work
(Required)
Cell
(Required)
Email
(Required)
Occupation
(Required)
Employer
(Required)
Employer Address
(Required)
Street Address
City
Province
ZIP / Postal Code
Is there a Secondary Applicant?
(Required)
Yes
No
Full Names - 2nd Applicant
(Required)
First Name
Surname
Upload ID Copy - 2nd Applicant
(Required)
Drop files here or
Select files
Max. file size: 5 MB.
Upload a copy of your ID or take a photo of your ID and upload the photo.
Tel Work - 2nd Applicant
(Required)
Cell - 2nd Applicant
(Required)
Email - 2nd Applicant
(Required)
Occupation - 2nd Applicant
(Required)
Employer - 2nd Applicant
(Required)
Employer Address - 2nd Applicant
(Required)
Street Address
City
Province
ZIP / Postal Code
THE DEBT COUNSELLOR:
NAME: Aluwani Lorraine Mathavhathe
COMPANY: Lantern Debt Counselling Services (NCRDC 1279)
PLACE: Pretoria, Lyttelton
SECTION B: SERVICES REQUIRED (Please tick the applicable box)
TRANSFER FROM CURRENT DC TO LANTERN DEBT COUNSELLING SERVICES NCRDC1279
(Required)
Yes
No
SECTION B1: REASONS FOR TRANSFER (Please tick the applicable box)
(Required)
A. Consumer not happy with the services they are getting from the Debt Counsellor First Choice
B. Consumer being misled by the new Debt Counsellor
C. Debt Counsellor transferring consumer to another Debt Counsellor (not a bulk transfer)
D. Debt Counsellors in one company transferring amongst themselves for different stages in the process
E. Consumer promised better offer by new Debt Counsellor
F. Other
PART C: DECLARATION BY CONSUMER
I,
(Required)
First Name
Last Name
declares as follows:
1. I undertake to comply with all requests from the debt counsellor to assist him/her to evaluate my state of indebtedness and the prospects of responsible debt management.
2. I hereby consent to the submission of my information to all registered credit bureaus by the debt counsellor.
3. 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 my credit information.
4. I confirm that the information contained in this document is, to the best of my knowledge true and correct.
5. I confirm that I have not been coerced/ influenced by the debt counsellor or any other person to sign the application form for transfer from the one DC to the current DC.
Signed at:
(Required)
Date
(Required)
MM slash DD slash YYYY
Date Signed
Primary applicant Signature
(Required)
Full Names
(Required)
First
Last
Primary applicant
THE DEBT COUNSELLOR:
NAME: Aluwani Lorraine Mathavhathe
COMPANY: Lantern Debt Counselling Services (NCRDC 1279)
PLACE: Pretoria, Lyttelton
PART 2
POWER OF ATTORNEY & FEE AGREEMENT SPECIAL POWER OF ATTORNEY TO LAUNCH AN APPLICATION IN TERMS OF SECTION 86 & 87 OF THE NATIONAL CREDIT ACT
I,
(Required)
First
Last
the undersigned Consumer(s), do hereby nominate, constitute and appoint the undersigned Debt Counsellor, with power of substitution to be my lawful agent in my name, place and stead with specific reference to the following:
1. with the power of substitution to be my agent and to assist me in my application for debt review;
2. I consent and ratify the bringing of an application in terms of section 86(8)(b) and section 87 of the National Credit Act for debt review by an attorney nominated by Lantern Debt Counselling Service;
3. When necessary, to employ and pay attorneys and/or counsel to appear and represent me/my Debt Counsellor which is to be appointed, in any court proceedings and/or before any judicial or other officers whosoever as he may consider advisable;
4. I acknowledge and accept liability for the payment of the debt as set out in the rehabilitation schedule that has been prepared by the Debt Counsellor;
5. I authorize the Debt Counsellor and/or attorney to appoint a Payment Distribution Agency that will be responsible for the distribution of my monthly payment to my creditors at a stipulated fee;
6. Authorization to the Debt Counsellor and attorney to institute legal proceedings on my behalf:
6.1 To institute proceedings in terms of section 86 & 87 of the National Credit Act and to prosecute, discontinue compromise, terminate or abandon such action or proceedings as the Agent shall see fit.
6.2 I hereby ratify and agree to ratify all and whatsoever the Debt Counsellor and or attorney shall lawfully do or cause to be done by virtue of this power of attorney.
7. 7. I declare that the power hereby created shall be irrevocable until cancelled in writing by me.
THUS DONE & SIGNED AT
(Required)
Date
MM slash DD slash YYYY
CONSUMER(S) / CLIENT(S) SIGNATURE
(Required)
CONSUMER(S) / CLIENT(S) SIGNATURE(S)
Full Names
(Required)
First
Last
THE DEBT COUNSELLOR:
NAME: Aluwani Lorraine Mathavhathe
COMPANY: Lantern Debt Counselling Services (NCRDC 1279)
PLACE: Pretoria, Lyttelton
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