Form 1A

ANNEXURE A
REGULATIONS RELATING TO DEBT COLLECTORS, 2003
APPLICATION FOR REGISTRATION AS DEBT COLLECTOR BY AN OFFICER IN THE EMPLOY OF A JURISTIC PERSON, A DIRECTOR OF A COMPANY OR A MEMBER OF A CLOSE CORPORATION
[Regulation 2(1)]

Please note:

1. In the case of a person who has in the preceding 10 years been convicted of an offence of 
    which violence, dishonesty, extortion or intimidation is an element, this application will only 
    be considered upon receipt of proof of exemption by the Minister for Justice and Constitutional 
    Development in terms of section 10(2) of the Debt Collectors Act, 1998 (Act No. 114 of 1998).

2. This form must be completed in block letters in black ink.

Please indicate:  New Registration  
                        Transfer from other juristic person / company / close corporation

In the case of a transfer:

• State name of previous juristic person, company or close corporation 
  ________________________________________________________________________

• Council registration number:  _________________________________________________
Please attach original registration certificate.

I, ________________________________________________________________________ 
  (full names and surname), 
hereby apply for registration as a debt collector and furnish the following particulars:

A. PERSONAL PARTICULARS

1. Date of birth:  ____________________________________________________________

2. Nationality:  _____________________________________________________________

3. Identity number:  _________________________________________________________
    (Attach a copy of identity document)

4. Residential address:  _____________________________________________________

    ____________________________________________ Postal code: ________________

5. Telephone number:  ______________________________________________________

6. Postal address:  _________________________________________________________

    ____________________________________________ Postal code: ________________

7. Occupation:  ____________________________________________________________

8. Business address:  _______________________________________________________

    ____________________________________________ Postal code: ________________

9. Telephone number:  ______________________________________________________

10. E-mail address:  _________________________________________________________

11. Cellular number:  _________________________________________________________

12. Fax number:  ____________________________________________________________


* Delete whichever is not applicable (Do not cross, tick or circle – answer “Yes” or “No”)

13. Are you on trial for an offence of which violence, dishonesty, extortion or intimidation is an 
      element or have you in the preceding 10 years been convicted of such offence? 

     *Yes / No.  If so, give details and, in the case of a conviction, indicate whether an application 
       for exemption in terms of section 10(2) has been lodged with the Minister of Justice and 
       Constitutional Development:

________________________________________________________________________

________________________________________________________________________

14. Have you ever, in terms of section 15 of the Act, been found guilty of improper conduct?  
*Yes / No.  If so, give details:

________________________________________________________________________

________________________________________________________________________

15. Have you ever been declared or certified by a competent authority to be of unsound mind?  
*Yes / No.  If so, give details:

________________________________________________________________________

________________________________________________________________________

16. Are you an unrehabilitated insolvent?  *Yes / No.  If so, give details:

________________________________________________________________________

________________________________________________________________________

17. Were you previously the holder of a debt collector’s certificate which has been withdrawn by 
       the Council?  *Yes / No.  If so, give details:

________________________________________________________________________

 ________________________________________________________________________

18. Have you already attained the age of 18?  *Yes / No.

________________________________________________________________________

B. LANGUAGE PROFICIENCY

State language(s) in which you are proficient and indicate level of proficiency as “Good”, “Fair” 
or “Poor” in the appropriate space.

Language     
Speak     
Read     
Write     

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