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Online Assessment

The online assessment is designed for your convenience and to improve our efficiency. Once you fill in the application form and submit, it will be sent to one of our specialists who will get in touch within 24hours. If you’d prefer we call you before you fill in the form, feel free to provide us with your contact details and press the CALL ME button on the right.

Application Form

1. We'd like to know more about you so please tell us who you are and where you're from.

Your Initials
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  • - Select Your Title -
  • Mr.
  • Mrs.
  • Miss.
  • Ms.
  • Mx.
  • Dr.
- Select Your Title -
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Your First Name
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  • - Select Your Gender -
  • Female
  • Male
  • Non-binary
  • Transgender
  • Intersex
  • Other
  • I prefer not to say
- Select Your Gender -
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Your Surname
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  • - Select Your Ethnic Group -
  • Black
  • White
  • Coloured
  • Indian
  • Asian
- Select Your Ethnic Group -
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Your ID Number
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Your Cellphone Number
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  • - Select Your Marital Status -
  • Single
  • Married
  • Widowed
  • Divorced
  • Separated
  • Registered partnership
  • De facto
- Select Your Marital Status -
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Your E-mail Address
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Your Street Address
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Province
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Country
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Zipcode
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2. To give you the upper hand, please provide us with your income and employment information.

The Name Of Your Company/Employer
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  • - Select Employment Type -
  • Permanent Full-time
  • Permanent Part-time
  • Temporary
  • Fixed Term
  • Independent Contractor
  • Internship
- Select Employment Type -
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Your Gross Salary (Before Deductions)
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Your Commissions
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Your Pension Income
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Any Other Income
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Your Occupation
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Your Overtime
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Your Property Rental Income
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Your Social Grants
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Total Income:
R0
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3. Now we need to know who and what is taking your hard earned money. Please furnish us with with your expenses.

Funeral Policies
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Medical Aid
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Field is required!
Tax
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Field is required!
Garnishees/Admin Orders
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Field is required!
Loans
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Field is required!
UIF
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Field is required!
Insurance
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Field is required!
Pension Fund
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Field is required!
Total Pay Slip Deductions
R0.00ZAR
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Field is required!
Domestic/Cleaning Service
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Field is required!
Rent/ House Hold expenses
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Field is required!
Security
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Field is required!
Bank Charges
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Field is required!
Mobile Phone & Data
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Field is required!
Vehicle Insurance
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Field is required!
Educational Fees
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Field is required!
Medical Expenses
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Field is required!
Telephone
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Field is required!
Clothing
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Field is required!
Municipal Rates and Taxes
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Field is required!
Other Living Expenses
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Field is required!
Groceries
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Field is required!
Petrol/Travel
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Field is required!
Water & Electricity
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Field is required!
Total Living Expenses
R0.00
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Field is required!
Balance Available To Service Debt
Nett Income less Essential Living expenses
R0.00
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Field is required!
Debt Status Total
The total amount by which you are under or over-indebted based on the above inputs.
R0.00
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Please read our terms and conditions before acknowledging you have done so and proceeding to accept them.

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Please tick the checkbox before proceeding!
Do you accept the terms and conditions?
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Submit

SA Debt Specialist is a trusted South Africa’s debt counselling service provider with over seven years worth of experience. We are registered and mandated by the National Credit Regulator (NCR) and governed by the DCASA. Helping you with your debt is our speciality.

152 North Rand Road, Bardene.

061 713 4252

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