ACKNOWLEDGEMENT OF DEBT I, the undersigned, (Full Name) IDENTITY NUMBER (the debtor) do hereby acknowledge to be truly and lawfully

indebted to (Person/Company) (hereinafter referred to as the creditor), in the sum of (Amount) (Amount in words) (hereinafter referred to as the capital) calculated as at (Date) for (the reason, e.g. purchase of a vehicle), which amount the debtor hereby undertakes and promises to pay in the manner and on the conditions set out hereafter: The debtor undertakes to repay the following amounts by means of a monthly stop order from the debtors bank account: 1. The capital amount of (Amount) (Amount in words) for a period of (number of repayments) months; on or before the end of each month; 2. The insurance amount of (Amount) (Amount in words)for a period of (number of repayments) months; on or before the end of each month; to (Person/Company), (Address), with account particulars as follows: (Bank Account Details) Ref: (Bank Deposit Reference)

2.

For the purpose of any action arising out of this Acknowledgement of Debt, the debtor chooses domicilium citandi et executandi at (Debtors address). Postal notices will go to P.O. Box (address).

3.

In the event of legal action being instituted by the Creditor for the recovery of any monies payable in terms hereof, the debtor hereby consents to the jurisdiction of the Magistrates Court in terms of Section 45 of Act 32 of 1944 as amended.

4.

I agree that this clause constitutes the written admission of liability and undertaking to pay the abovementioned debt in instalments in terms of Section 57 of the Magistrates Court Act No. 32 of 1944 or any statutory amendment thereof or substitute therefore, and I further agree that this clause constitutes both the written offer by me and written acceptance by the creditor as prescribed by the aforementioned Section.

5.

And the debtor further agrees that in the event of any legal action being instituted as stated above, the debtor will pay the costs thereof on an attorney and client scale.

6.

All payments made by the debtor shall be allocated first to costs, then to interest and thereafter to the capital.

7.

In the event of proceedings being instituted against the debtor by any third party or in the event of the debtor failing to pay any one instalment on due date, or in the event of the debtor being liquidated, the total capital amount due in terms hereof together with costs and interest incurred as aforesaid, shall become due and payable forthwith without further notice to the debtor.

8.

The debtor hereby expressly renounces and waives all legal benefits and exceptions, which may be available to the debtor, and the debtor declares itself to be fully acquainted with the meaning and effect of such exceptions and of the renunciation thereof.

9.

No waiver of any of the terms and conditions of this acknowledgement of debt shall be binding or effectual for any purpose unless expressed in writing and signed by the party hereto giving the same, and any such waiver shall be effective only in the specific instance and for the purpose given.

10.

No failure of delay on the part of either party hereto in exercising any right, power or privilege hereunder shall operate as a waiver thereof, nor shall any single or partial exercise of any right, power of privilege preclude any other or further exercise thereof or the exercise of any right, power or privilege.

11.

I agree that no variation, waiver, estoppel or cancellation of this Acknowledgement of Debt or part hereof, will be of any force or effect unless it is in writing and signed by the Creditor or their attorneys acting on their behalf, and myself.

12.

This agreement does not constitute a novation to any rights or agreements between the debtor and the creditor.

DATED at _________________________________ on this __________ day of ________________________ 20____.

_______________________ (Debtor)

AS WITNESSES:

1.

_________________________

2.

_________________________