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ID Number
First Name
Cell Number
Home Phone No
Work Phone No
Home AddressLine 1
SuburbLine 2
Town/CityLine 3
Postal CodeLine 4
Company Name
Employment Date
Gross Salary
Net Salary
Monthly Expenses
Required Loan Amount (R)
Account Number
I agree to the terms and conditions (Disclaimer)
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Terms and Conditions

Name and SurnameElectronic Signature
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In case of cancellation as a result of breach on the part of the applicant/client, the remaining balance shall become immediately due and owing to Debt Consol Loans. In the event Debt Consol Loans  should hand the applicant/client over for collection of any amounts owing to Debt Consol Loans  , Debt Consol Loans  shall impose an administration cost of 25% (Twenty Five Percent) added to the outstanding amount owing by the applicant/client to Debt Consol Loans. .All legal fees associated with the collection of monies owing to Debt Consol Loans in terms of these policies, being it for breach or otherwise shall be paid by, or be liable by the applicant/client on an attorney and client scale.