Fax Nr / Faks: 0123464997

1. Suite 6A, Monpark Gebou/Building 76 Skilpad Laan/Avenue, Monument Park Pretoria Tel: 012 346-4612 Fax: 012 346-4997 Email: lomprok@telkomsa.net lomprokpta@telkomsa.net LOMBARDS Fax Nr / Faks: 0123464997 Permission to Obtain Credit Information I, ______________________ (ID_____________________), authorise Lombards Attorneys to obtain my complete credit profiles from TransUnion and Experian and XDS; to obtain any and all balance and statement information from any of my Creditors (only if I instruct Lombards Attorneys to perform Voluntary Debt Distribution); to pass my credit information to Lombards Attorneys so that they can provide me with a free quote to clear my credit record (only if there is negative Information) and to store my credit record and account information on Lombards Attorneys confidential database for 30 days from the date on which Lombards Attorneys receives it. Your Report cost only R205.20 inclusive of Vat Our banking details: Lombards Attorneys Trust Absa Bank Ghandi Square Branch code 503005 Account number 4055400102 Please use your ID number as Reference when making the deposit Name and Surname: _____________________ Cell number: _____________________ Email address: _____________________ Signature: ______________________ Date: _______________________ • Next steps: • Please send us your Proof of ID and this signed Permission Form to fax number 012 346 4997 • Fax your Proof of Payment as well (not necessary if you paid by credit card) to the same number • Once received, we will process your order and send your Report within 1 business day.