Form 3

Debt collector's certificate

[Regulation 4]

NO. OF CERTIFICATE:.........................

Full names .............................................................................................................................

Identity number/Registration number ...................................................................................

Address .................................................................................................................................

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This is to certify that the debt collector whose name appears on this certificate is registered to hold a debt collector's certificate.

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Date of issue

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Chairperson: Council for Debt Collectors

This certificate shall only be valid if it bears the seal of the Council for Debt Collectors