Regulations > Regulations relating to Debt Collectors, 2003 > Annexures > Annexure A : Forms

Form 2

Application for exemption

[Regulation 3(1)]

I, ........................................................................... (full names), *a director/member of ....................................................................................(name of *company/close corporation) hereby apply to be exempted from the disqualification contemplated in section 10(1)(a)(i) of the Debt Collectors Act, 1998 (Act No. 114 of 1998), and in support of this application submit the following information:

1. Identity number or date of birth: ....................................................................................

2. Nationality: ....................................................................................................................

3. Residential address: .......................................................................................................

.......................................................................................................................................

............................................................................ Postal code: ......................................

4. Telephone number: .......................................................................................................

5. Postal address: ..............................................................................................................

............................................................................ Postal code: ......................................

6. Work address: ................................................................................................................

.......................................................................................................................................

............................................................................ Postal code: ......................................

7.	Telephone number: .......................................................................................................

8.	E-mail address: ...............................................................................................................

9.	Cellular number: ............................................................................................................

10.	Fax number: ...................................................................................................................

11.	Full particulars of offence(s) of which violence, dishonesty, extortion, or intimidation is an element, convicted of in the preceding 10 years.

Particulars of charge(s) convicted of: ..............................................................................

Date(s) of conviction(s): .................................................................................................

Particulars of sentence(s): ..............................................................................................

12.	The abovementioned conviction(s) (s)should not be a disqualification for exercising the occupation of debt collector as the circumstances relating to the commission of the offence were as follows:

.......................................................................................................................................

I declare that the particulars furnished by me are in all respects complete and correct.

Signed at ...................................... this ................ day of .....................................20 .............

...................................................................

Signature of Applicant

*Delete if not applicable

Remarks:

In terms of the Regulations relating to Debt Collectors, 2003, it is an offence to furnish false or misleading particulars or information or make a false or misleading statement.

Debt Collectors Act, 1998 (Act No. 114 of 1998)

Regulations

Regulations relating to Debt Collectors, 2003

Annexures

Annexure A : Forms

Form 2 : Application for exemption [Regulation 3(1)]