ACKNOWLEDGEMENT OF DEBT

1. THE DEBTOR

NAME: ………………………………………………..

IDENTITY NUMBER: ……………………………….

CELL NUMBER: …………………………………….

ADDRESS: …………………………………………..

…………………………………………………………

…………………………………………………………

…………………………………………………………

E-MAIL: ………………………………………………

2. THE CREDITOR

NAME: ………………………………………………..

…………………………………………………………

…………………………………………………………

…………………………………………………………

TEL: ………………………………………………….

3. ACKNOWLEDGMENT OF DEBT

The debtor acknowledges being indebted to the creditor in the sum of R……… (……………………), being the capital amount due in respect of a motor vehicle collision that occurred on the …………….. at or near Stellenbosch.

 

 

4. METHOD OF PAYMENT
   • The debtor undertakes to pay the outstanding amount as mentioned in 3 above, in instalments of R……. (…………….) per month from the ……………….., with further payments to be made on or before the third of each succeeding month, until date of payment in full.

 

• The debtor agrees to make all payments due in respect hereof on

The date, as abovementioned, directly at the offices of attorneys …………………………………., alternatively directly into the account of ………………………………, the particulars being thereof being as follows:

 

…………………………………………………….

…………………………………………………….

…………………………………………………….

…………………………………………………….

 

REFERENCE:  …………………………………

 

• In the event of the debtor paying directly into the bank (trust)

account of attorneys ………………………, the debtor hereby undertakes to supply documentary proof (i.e. deposit slip), of such payment to ……………………… on the date of payment. Should …………………………… Attorneys receive no such notification as stipulated and subsequent costs are incurred on behalf of the creditor, same will be the account of the debtor on an attorney and client scale.

 

5. DEFAULT BY DEBTOR IN TERMS THEREOF

 

5.1 The debtor acknowledges that the full outstanding amount become immediately due and payable if any payment due respect hereof, is not paid on the date as agreed herein.

 

5.2       The debtor further acknowledges that should any payment not be

paid on the date stipulated herein, interest will accrue on the full  outstanding amount, at 15, 5% per annum, from 25 August 2010 until date of settlement in full.

 

5.3       The debtor hereby specifically agrees to an emoluments

attachement order being granted against the debtor if the debtor

does not honour his obligation of terms hereof.

 

6. CHANGE OF ADDRESS

The debtor undertakes to advise the Creditor’s attorneys, _________________, should the debtor’s address change. The debtor further agrees that if he refrains from advising the abovementioned attorneys of his change of address, and his address has to be verified, that he will be liable for the cost incurred by the creditor to ascertain his new address.

 

7. COST

The debtor hereby accepts liability for legal costs incurred by the creditor, should the creditor institute action against the debtor due to the debtor’s non-compliance with the terms hereof.

 

 

8. JURISDICTION

The debtor agrees to the jurisdiction of the Magistrate’s Court in terms of Section 28 of Act 32 of 1944 and acknowledges that the creditor has the discretion to proceed with action in any Court which might have jurisdiction in respect of this matter.

 

9. CHANGE OF ADDRESS

The debtor chooses his address as mentioned in paragraph 1 hereof as the address where he will accept service and delivery of any notices, which is given in respect hereof.

 

 

SIGNED AT _____________________ ON THE _____ DAY OF __________2013

 

 

AS WITNESS:

 

1._________________________

 

 

 

2. ________________________ ____________________

DEBTOR