Debt Counselling Form

First Name

Surname

Mobile: (should be Whatsapp enabled)

Email Address

Current State and Country

Marital Status

Organization/Company and Position

Instagram & Facebook handle

What is the Nature of the Debt?

Amount you are owing

When was the loan taken (month/year)

Reason you took the Loan

Any current repayment plan (the one initially agreed to)

When last did you contact your Creditor/Lender/Investors (i.e. the person or company you are owing)

How would you like us to reach you?

What solution are you Looking at?

What do you want to achieve at the end of this Debt Counselling Session?

What is your current means of livelihood?

State how you plan to pay and when you think you will be able to start making payments

Do you want to pay back or you want the debt to be written off?

Anything else you would like us to know?