Part one- Personal Information

Part two- Income

Part three- Total Living Expenses

Part four- Debtor Obligations

Part five- Declaration by applicant

1. I undertake to comply with all requests from Credit Cleaner and their representative attorneys, in order to assist them to evaluate my state of indebtedness and the prospects for removal of my debt review status.
2. I hereby consent to the submission of my information to all registered credit bureaus.
3. I also consent that Credit Cleaner may obtain my credit records from any/all registered credit bureaus and any other registers which may contain any of my credit information.
4. I understand that Credit Cleaner may prepare a court application in respect of the removal of my debt review status. I further understand that the outcome of such an application is at the discretion of the magistrate and that Credit Cleaner do not take responsibility for the decision of the magistrate.
5. I confirm that the information contained in this document is, to the best of my knowledge, true and correct.