Online Form

Surname

First name of insolvent:

First name of spouse

Cell Number

Alternative number

Email

Preferred method of contact

Date of Birth

ID Number

Spouse date of Birth

Spouse ID Number

Marital Status Marital StatusMarried in Community of PropertyMarried out of Community of PropertyCustomary MarriageDivorcedSingleWidowWidower

Present occupation and work addres of insolvent

Present occupation and work addres of spouse

Present residential addres of insolvent

Present residential addres of spouse

Sequestration Date Provisional

Sequestration Date Final

Address of insolvent at the time of sequestration

Occupation or status of insolvent at the time of sequestration

I hereby give Rehab Hub consent to process my personal information, in accordance with the provisions of the Protection of Personal Information Act, Act 4 of 2013 (“POPI Act”), for all purposes related to the carrying out of Rehab Hub’s mandate, given by me, to enable Rehab Hub to ascertain whether I am in a position to be rehabilitated. The personal information is the personal information as defined in the POPI Act and includes, but is not limited to my surname, first name, the first name of my spouse, cellphone numbers, email addresses, date of birth, Identity number, spouse’s date of birth, spouse’s Identity number, my marital status, my present occupation, work address and residential address including the present occupation of my spouse, my spouse’s work address and residential address and all detail pertaining to my insolvency required by Rehab Hub. Such consent shall extend to the sharing of my personal information to third parties that are necessary to assist Rehab Hub with procuring information on my insolvency and to bring a court application to the necessary court for my possible rehabilitation. Rehab Hub may furthermore share my personal information with legal counsel who may be approached by Rehab Hub for advice and assistance for my possible rehabilitation. I hereby give Rehab Hub consent to process my personal information, in accordance with the provisions of the Protection of Personal Information Act, Act 4 of 2013 (“POPI Act”), for all purposes related to the carrying out of Rehab Hub’s mandate, given by me, to enable Rehab Hub to ascertain whether I am in a position to be rehabilitated. The personal information is the personal information as defined in the POPI Act and includes, but is not limited to my surname, first name, the first name of my spouse, cellphone numbers, email addresses, date of birth, Identity number, spouse’s date of birth, spouse’s Identity number, my marital status, my present occupation, work address and residential address including the present occupation of my spouse, my spouse’s work address and residential address and all detail pertaining to my insolvency required by Rehab Hub. Such consent shall extend to the sharing of my personal information to third parties that are necessary to assist Rehab Hub with procuring information on my insolvency and to bring a court application to the necessary court for my possible rehabilitation. Rehab Hub may furthermore share my personal information with legal counsel who may be approached by Rehab Hub for advice and assistance for my possible rehabilitation. Yes