Gas Regulator Levies Act, 2002
R 385
National Credit Act, 2005 (Act No. 34 of 2005)RegulationsNational Credit Regulations, 2006Annexure A : FormsDeclaration 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:
| 1. | 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
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Description |
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Credit provider's trading name: |
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Credit provider's NCRCP number: |
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Date of application for credit: |
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Transaction number |
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Principle debt of credit transaction |
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Credit applicant/s first name |
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Credit appliciant/s family name |
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Credit applicant/s identity/passport number |
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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
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Monthly Necessary Expenses |
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Gross Monthly Income |
Applicable monthly necessary expenses
(Calculated by the credit provider as per Table 1 above
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Consumer declared expenses
(As per consumer declaration) |
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R
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R |
R |
Section 3 : Consumer Declaration
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3A |
Monthly Expenses |
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3.1 |
Accommodation expenses |
Monthly |
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Amount |
R |
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[ ] |
Own home: provide address |
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[ ] |
Living with family: insert name/s and contact details |
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Living with friends: insert name/s and contact details |
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[ ] |
Other (please explain) |
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3.2 |
Transport expense |
Monthly |
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[ ] |
Live close to work/school/college: give address |
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[ ] |
Transported by family: insert name/s and contact details |
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Amount |
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[ ] |
Own transport |
R |
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[ ] |
Transported by family: insert name/s and contact details |
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[ ] |
Other (please explain) |
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3.3 |
Food expense |
Monthly |
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[ ] |
Provided by employer: insert name |
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Amount |
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Provided by family: insert name/s and contact details |
R |
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Provided by friends: insert name/s and contact details |
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Other (please explain) |
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3.4 |
Education expense |
Monthly |
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Amount |
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Provided by family: insert name/s and contact details |
R |
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[ ] |
Provided by friends: insert name/s and contact details |
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Not studying at the moment |
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No school going children |
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Other (please explain) |
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3.5 |
Medical expense |
Monthly |
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[ ] |
Provided by employer: insert name/s and contact details |
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Amount |
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[ ] |
Provided by family: insert name/s and contact details |
R |
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Provided by friends: insert name/s and contact details |
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Own medical expense |
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[ ] |
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Other (please explain) |
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3.6 |
Water and electricity |
Monthly |
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Amount |
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Water and Electricity: |
R |
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Other (please explain) |
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3.7 |
Maintenance expense |
Monthly |
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Amount |
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[ ] |
Living with family: insert name/s and contact details |
R |
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Payment provided by court order |
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Other (please explain) |
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[Annexure A (Declaration) inserted by Notice No. R. 202, GG 38557 dated 13 March 2015]
