National Credit Act Affordability Form

Please be advised that the National Credit Act require us to ask you for your consent to perform a credit check
with a bureau to determine whether you can afford the credit that we might give you. (As per new National Credit
Act 1 June 2007)

This form is to be completed by the person responsible for paying the account and once completed it is
to be returned to
Theo Hagins– Fax: 0866 060658

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Name and surname of student: _____________________________________________

Identity Number of student: _____________________________________________
Contact Number: _____________________________________________

Name and surname of guarantor ____________________________________________

(Person responsible for payment if different from student)
Identity Number of guarantor: ____________________________________________
Contact Number: __________________________________________________________________

Course applying for: ______________________________________________________

Affordability Check

Gross Income R , ,
House expenses R , ,
Car expenses R , ,
Food expenses R , ,
School expenses R , ,
Other expenses R , ,
Nett income R , ,

* Please attach a copy of your salary slip and ID document

Do you consent to us performing a credit check on you?

Please tick:√
I confirm that I give consent to perform the credit check

Do you confirm that the information you have given us is true and correct?

I confirm that the information given is true and correct.

Signature: __________________________ Date: _____________