Regulations > National Credit Regulations, 2006 > Schedules > Annexure A : Forms > Declaration of Consumer's Necessary Expense Questionnaire

Instructions:

i.	This questionnaire must be completed in instances where a consumer discloses minimum living expenses that are below those defined in the Regulations.

ii.	In case of joint applications only one questionnaire must be completed that considers the details of all applicants

Consumer Declaration:

The consumer/s completing this questionnaire is hereby reminded that in terms of section 81(1) of the National Credit Act when applying for a credit agreement, and while that credit agreement is being considered by the credit provider, the prospective consumer must fully and truthfully answer any requests for information made by the credit provider as part of the assessment. Misrepresentation of facts will be dealt with in terms of the applicable law.

Section 1 : Applicant Details

Description
Credit provider's trading name:
Credit provider's NCRCP number:
Date of application for credit:
Transaction number
Principle debt of credit transaction
Credit applicant/s first name
Credit appliciant/s family name
Credit applicant/s identity/passport number
Consumer signature

Section 2 : Necessary Expenses

Declared monthly expenses by the consumer

(Please fill in for the relevant income band. In the case of joint applications the joint annual gross income of all applicants must be used.)

Table A : Necessary Expense Norms Terms

Monthly Necessary Expenses

Gross Monthly Income

Applicable monthly necessary expenses

(Calculated by the credit provider as per Table 1 above

Consumer declared expenses

(As per consumer declaration)

Section 3 : Consumer Declaration

3A	Monthly Expenses
3.1	Accommodation expenses	Monthly
Amount		R
[ ]	Own home: provide address
[ ]	Living with family: insert name/s and contact details
[ ]	Living with friends: insert name/s and contact details
[ ]	Other (please explain)

3.2	Transport expense	Monthly

[ ]	Live close to work/school/college: give address
[ ]	Transported by family: insert name/s and contact details
Amount
[ ]	Own transport	R
[ ]	Transported by family: insert name/s and contact details
[ ]	Other (please explain)

3.3	Food expense	Monthly

[ ]	Provided by employer: insert name
Amount
[ ]	Provided by family: insert name/s and contact details	R
[ ]	Provided by friends: insert name/s and contact details
[ ]	Other (please explain)

3.4	Education expense	Monthly

Amount
[ ]	Provided by family: insert name/s and contact details	R
[ ]	Provided by friends: insert name/s and contact details
[ ]	Not studying at the moment
[ ]	No school going children
[ ]	Other (please explain)

3.5	Medical expense	Monthly

[ ]	Provided by employer: insert name/s and contact details
Amount
[ ]	Provided by family: insert name/s and contact details	R
[ ]	Provided by friends: insert name/s and contact details
[ ]	Own medical expense
[ ]
[ ]	Other (please explain)

3.6	Water and electricity	Monthly

Amount
[ ]	Water and Electricity:	R
[ ]	Other (please explain)

3.7	Maintenance expense	Monthly

Amount
[ ]	Living with family: insert name/s and contact details	R
[ ]	Payment provided by court order
[ ]	Other (please explain)

[Annexure A (Declaration) inserted by Notice No. R. 202, GG 38557 dated 13 March 2015]

National Credit Act, 2005 (Act No. 34 of 2005)

Regulations

National Credit Regulations, 2006

Annexure A : Forms

Declaration of Consumer's Necessary Expense Questionnaire