Apply Here | Debt Shield

Please provide your basic details in the form below. This will help us to get started with your application process and ensure that we have your correct contact information.

Fill Out the Basic Information Form

Name

Surname

Email Address

Phone Number

Marital Status

Single Married In C.O.P Out C.O.P Divorced

Preferred Language

English Afrikaans Xhosa Zulu Other

ID Number

Home Address

Creditor

Account Number

Outstanding Balance

Current Balance

Previous Debt Counselling

Yes No

Sub-Total

Total

Closer Comments

Product

Current Installments

Reduced Installments

By submitting this form, I acknowledge and agree to the following: Accuracy of Information: I confirm that the information provided is accurate and truthful to the best of my knowledge. Use of Information: I consent to the use of my personal information by Debt Shield for the purpose of processing my application and providing debt management services. Confidentiality: I understand that my personal information will be kept confidential and will only be shared with third parties as necessary to provide the requested services. Obligations: I agree to complete and submit the full application form as required to proceed with my request for debt management services.

Download and Complete the Full Application PDF

After submitting your basic information, please download the full application form by clicking the link below. This PDF file contains all the necessary details and additional information we need to fully process your application.

Instructions for Completing the PDF:

Print the Form: After downloading, print the PDF file.
Fill Out the Form: Complete all sections of the form with a pen. Be sure to fill out every field accurately to avoid delays in processing.
Sign the Form: Make sure to sign the form where required.
Submit the Form: Once completed, scan or take a clear photo of the filled-out form and send it back to us via email at admin@debtshield.co.za or by mail to our office address at 158 3rd Street, Markon Junxion, Springs, South Africa