Financial
Disclosure Form
Step
1
of
25
4%
Please fill in this form fully and accurately. Where any box is not applicable, type “N/A”.
You have a duty to the court to give a full, frank and clear disclosure of all your financial and other relevant circumstances.
A failure to give full and accurate disclosure may result in an adverse court order.
If you are found to have been deliberately untruthful, criminal proceedings may be brought against you for perjury and/ or fraud.
The information given in this form must be confirmed under oath or affirmation. Proceedings for contempt of court may be brought against a person who makes or causes to be made, a false statement in a document verified under oath or affirmation.
You must attach documents to the form where they are specifically sought and you may attach other documents where it is necessary to explain or clarify any of the information you give.
Essential documents that must accompany this statement are detailed in the form.
If you are in doubt about how to complete any part of this form you should contact us in order to obtain advice.
Email
(Required)
Enter Email
Confirm Email
The Parties
The Plaintiff/ Applicant
(Required)
The Defendant/ Respondent
(Required)
Case number if summons has already been issued
Date of issue of summons
DD slash MM slash YYYY
Party making the financial disclosure
(Required)
General Information
Personal Details
Name
(Required)
First
Last
ID or Passport Number
(Required)
Date of Birth
(Required)
DD slash MM slash YYYY
Residential Address
(Required)
Occupation
(Required)
Marital details
Please select one option
Married in community of property
Married in community of property
Married out of community of property with the inclusion of the accrual system
Married out of community of property with the inclusion of the accrual system
Married out of community of property with the exclusion of the accrual system
Married out of community of property with the exclusion of the accrual system
Other
If other, specify:
Type of marriage
(Required)
Civil
Civil Union
Customary
Muslim
Date of Marriage
(Required)
DD slash MM slash YYYY
Date of Separation
DD slash MM slash YYYY
Details of any children in the family
Name
First
Last
Date of birth
Day
DD
Month
MM
Year
YYYY
With whom does the child live with?
Add another Child?2
(Required)
Yes
No
Child 2
Name
First
Last
Date of birth
Day
DD
Month
MM
Year
YYYY
With whom does the child live with?
Add another Child?3
(Required)
Yes
No
Child 3
Name
First
Last
Date of birth
Day
DD
Month
MM
Year
YYYY
With whom does the child live with?
Add another Child 4?
(Required)
Yes
No
Child 4
Name
First
Last
Date of birth
Day
DD
Month
MM
Year
YYYY
With whom does the child live with?
Add another Child 5?
(Required)
Yes
No
Child 5
Name
First
Last
Date of birth
Day
DD
Month
MM
Year
YYYY
With whom does the child live with?
Add another Child 6?
(Required)
Yes
No
Child 6
Name
First
Last
Date of birth
Day
DD
Month
MM
Year
YYYY
With whom does the child live with?
Have all the court cases been recorded?
Case 1
Case No
Court
Type of Proceedings
Add another case 2?
(Required)
Yes
No
Case 2
Case No
Court
Type of Proceedings
Add another case?3
(Required)
Yes
No
Case 3
Case No
Court
Type of Proceedings
Section A & B: Immovable property and personal assets
Documentation required for attachment to this section: a) A copy of any valuation of the property obtained within the last six months (e.g. Estate agent, municipal or online Lightstone valuation) b) A recent home loan statement confirming the sum outstanding on each mortgage registered over the property
Upload copy of valuation of property
Drop files here or
Select files
Max. file size: 128 MB.
Upload recent home loan statement confirming the sum outstanding on the mortgage registered over the property
Max. file size: 128 MB.
Property address (including Erf number)
(Required)
Mortgage company/ Bank name(s) and account number(s)
(Required)
Details of who owns the property and the extent of your legal and beneficial interest in it
(Required)
Current market value of the property
(Required)
Balance(s) outstanding on any mortgage(s)
(Required)
Who pays the mortgage bond instalments and in what proportions?
(Required)
Total equity in the property
(Required)
TOTAL value of your interest in this property
(Required)
Please complete this section if you have an additional property
Documentation required for attachment to this section: a) A copy of any valuation of the property obtained within the last six months (e.g. Estate agent, municipal or online Lightstone valuation) b) A recent home loan statement confirming the sum outstanding on each mortgage registered over the property
Property address (including Erf number)
Mortgage company/ Bank name(s) and account number(s)
Details of who owns the property and the extent of your legal and beneficial interest in it
Current market value of the property
Balance(s) outstanding on any mortgage(s)
Who pays the mortgage bond instalments and in what proportions?
Estimate the costs associated with the sale of this property, should this property be sold (e.g. estate agent commission, compliance certificate, transfer costs etc.)
Total equity in the property
TOTAL value of your interest in this property
Do you have additional Property?
(Required)
Yes
No
More Properties
Property address (including Erf number)
Mortgage company/ Bank name(s) and account number(s)
Details of who owns the property and the extent of your legal and beneficial interest in it
Current market value of the property
Balance(s) outstanding on any mortgage(s)
Who pays the mortgage bond instalments and in what proportions?
Estimate the costs associated with the sale of this property, should this property be sold (e.g. estate agent commission, compliance certificate, transfer costs etc.)
Total equity in the property
TOTAL value of your interest in this property
Section C1: Personal Bank Accounts (complete separately for each personal bank account in which you have an interest)
Details of all personal bank accounts that you hold or have held at any time in the last twelve months and which are or were either in your own name or in which you have had any interest. This applies whether any such account is in credit or in debit. If the account is overdrawn, show a minus figure.
Documentation required for attachment to this section: For each account listed, all statements covering the last 6 months
Upload statement of account covering the last 6 months
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
Name of bank
(Required)
Type of Account (e.g. current)
(Required)
Account number
(Required)
Balance at the date of this form
(Required)
Hidden
C1 Balance
Add another bank account
(Required)
Yes
No
Bank account 2
Upload statement of account covering the last 6 months
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
Name of bank
(Required)
Type of Account (e.g. current)
(Required)
Account number
(Required)
Balance at the date of this form
(Required)
Add another bank account?3
(Required)
Yes
No
Bank Account 3
Upload statement of account covering the last 6 months
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
Name of bank
(Required)
Type of Account (e.g. current)
(Required)
Account number
(Required)
Balance at the date of this form
(Required)
Add another bank account?4
(Required)
Yes
No
Bank Account 4
Upload statement of account covering the last 6 months
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
Name of bank
(Required)
Type of Account (e.g. current)
(Required)
Account number
(Required)
Balance at the date of this form
(Required)
Add another bank account?5
(Required)
Yes
No
Bank Account 5
Upload statement of account covering the last 6 months
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
Name of bank
(Required)
Type of Account (e.g. current)
(Required)
Account number
(Required)
Balance at the date of this form
(Required)
Section C2: Investments (complete separately for each investment in which you have an interest in)
Details of all investments, including shares, bonds, unit trusts, other investments and other quoted securities that you hold or have an interest in and investments (other than already recorded previously). Do not include dividend income as this will be dealt with separately later on.
Documentation required for attachment to this section: Latest statement relating to each investment.
Upload the latest statement of investment covering
Drop files here or
Select files
Max. file size: 128 MB.
Name
(Required)
Type of Investment
(Required)
Size of holding
(Required)
Investment number
(Required)
Current Value
(Required)
Add another investment account?2
(Required)
Yes
No
Investment 2
Upload the latest statement of investment covering
Drop files here or
Select files
Max. file size: 128 MB.
Name
(Required)
Type of Investment
(Required)
Size of holding
(Required)
Investment number
(Required)
Current value
(Required)
Hidden
C2
Add another investment account?3
(Required)
Yes
No
Investment 3
Upload the latest statement of investment covering
Drop files here or
Select files
Max. file size: 128 MB.
Name
(Required)
Type of Investment
(Required)
Size of holding
(Required)
Investment number
(Required)
Current value
(Required)
Add another investment account?4
(Required)
Yes
No
Investment 4
Upload the latest statement of investment covering
Drop files here or
Select files
Max. file size: 128 MB.
Name
(Required)
Type of Investment
(Required)
Size of holding
(Required)
Investment number
(Required)
Current value
(Required)
Add another investment account?5
(Required)
Yes
No
Investment account 5
Upload the latest statement of investment covering
Drop files here or
Select files
Max. file size: 128 MB.
Name
(Required)
Type of Investment
(Required)
Size of holding
(Required)
Investment number
(Required)
Current value
(Required)
Section C3: Life insurance and/or endowment policies (complete separately for each life insurance and/or endowment policy you in which have an interest in)
Details of all life insurance and/ or endowment policies that you hold or have an interest in. Also include those that do not have a surrender value.
Documentation required for attachment to this section: A surrender valuation of each policy that has a surrender value and/or a full policy schedule from your broker.
Upload statement of the policy reflecting the surrender value and/or a full policy schedule from your broker
Drop files here or
Select files
Max. file size: 128 MB.
Name of Policy
(Required)
Type of Policy
(Required)
Policy number
(Required)
Current surrender value
(Required)
Current beneficiaries
(Required)
Hidden
C3
Add another Policy
(Required)
Yes
No
Policy 2
Upload statement of the policy reflecting the surrender value and/or a full policy schedule from your broker
Drop files here or
Select files
Max. file size: 128 MB.
Name of Policy
(Required)
Type of Policy
(Required)
Policy number
(Required)
Current surrender value
(Required)
Current beneficiaries
(Required)
Add another Policy?3
(Required)
Yes
No
Policy 3
Upload statement of the policy reflecting the surrender value and/or a full policy schedule from your broker
Drop files here or
Select files
Max. file size: 128 MB.
Name of Policy
(Required)
Type of Policy
(Required)
Policy number
(Required)
Current surrender value
(Required)
Current beneficiaries
(Required)
Add another Policy?4
(Required)
Yes
No
Policy 4
Upload statement of the policy reflecting the surrender value and/or a full policy schedule from your broker
Drop files here or
Select files
Max. file size: 128 MB.
Type of Policy
(Required)
Name of Policy
(Required)
Policy number
(Required)
Current surrender value
(Required)
Current beneficiaries
(Required)
Add another Policy?5
(Required)
Yes
No
Policy 5
Upload statement of the policy reflecting the surrender value and/or a full policy schedule from your broker
Drop files here or
Select files
Max. file size: 128 MB.
Name of Policy
(Required)
Type of Policy
(Required)
Policy number
(Required)
Current surrender value
(Required)
Current beneficiaries
(Required)
Section C4: Monies that are OWED TO YOU (complete separately for each amount owed to you)
Details of all monies that are OWED TO YOU in excess of R2 000,00. Do not include sums owed by way of loan account in your business, but do include loan accounts in Trusts.
Brief description of money owed and by whom
(Required)
Balance outstanding
(Required)
Hidden
C4
(Required)
Add another debtor?
(Required)
Yes
No
Debtor 2
Brief description of money owed and by whom
(Required)
Balance outstanding
(Required)
Add another debtor?3
(Required)
Yes
No
Debtor 3
Brief description of money owed and by whom
(Required)
Balance outstanding
(Required)
Add another debtor?4
(Required)
Yes
No
Debtor 4
Brief description of money owed and by whom
(Required)
Balance outstanding
(Required)
Section C5: Cash sums held in excess of R2,000.00 (complete separately for each cash sum held in excess of R2,000.00)
Details of all cash sums held in excess of R2 000,00. You must state where it is held and the currency it is held in (eg. US$ 500 in a safe at home).
Where is the cash sum held?
(Required)
Total amount of cash sum
(Required)
Currency of cash sum
(Required)
Total current value of your interest
(Required)
Hidden
C5
Do you have more places where cash is held?2
(Required)
Yes
No
Cash Sum 2
Where is the cash sum held?
(Required)
Total amount of cash sum
(Required)
Currency of cash sum
(Required)
Total current value of your interest
(Required)
Do you have more places where cash is held?3
(Required)
Yes
No
Cash Sum 3
Where is the cash sum held?
(Required)
Total amount of cash sum
(Required)
Currency of cash sum
(Required)
Total current value of your interest
(Required)
Do you have more places where cash is held?4
(Required)
Yes
No
Cash sum 4
Where is the cash sum held?
(Required)
Total amount of cash sum
(Required)
Currency of cash sum
(Required)
Total current value of your interest
(Required)
Section C6: Personal Belongings of R5,000.00 or more individually (complete separately for each personal belonging of R5,000.00 or more)
Details of personal belongings individually worth more than R5 000,00. INCLUDE: • Vehicles (trade value) • Collections, pictures and jewellery • Furniture and house contents (present market value, not replacement costs)
Brief description of item
(Required)
Total Current Value of your Item1
(Required)
Hidden
C6
Hidden
C1: C:6
Add antoher item?2
(Required)
Yes
No
Item 2
Brief description of item
(Required)
Total Current Value of your item2
Add antoher item?3
(Required)
Yes
No
Item 3
Brief description of item
(Required)
Total Current Value of your item3
(Required)
Add antoher item?4
(Required)
Yes
No
Item 4
Brief description of item
(Required)
Total Current Value of your item4
(Required)
Section D: Capital: Liabilities (complete separately for each liability)
Details of any liabilities you have.
EXCLUDE liabilities already shown such as:
Mortgage/home loans
Any overdrawn bank accounts
INCLUDE:
Money owed on credit cards and store cards
Bank loans
Hire purchase/finance agreements eg. On vehicles
List all credit and store cards held including those with a nil or positive balance.
Liability (E.g. Edgars, Nedbank etc.)
(Required)
Type of Credit (E.g. Store card, credit card etc.)
(Required)
Total current value of your interest in the liability
(Required)
Add another liability?2
(Required)
Yes
No
Liability2
Liability (E.g. Edgars, Nedbank etc.)
(Required)
Type of Credit (E.g. Store card, credit card etc.)
(Required)
Total current value of your interest in the liability
(Required)
Add another liability?3
(Required)
Yes
No
Liability3
Liability (E.g. Edgars, Nedbank etc.)
(Required)
Type of Credit (E.g. Store card, credit card etc.)
(Required)
Total current value of your interest in the liability
(Required)
Add another liability?4
(Required)
Yes
No
Liability4
Liability (E.g. Edgars, Nedbank etc.)
(Required)
Type of Credit (E.g. Store card, credit card etc.)
(Required)
Total current value of your interest in the liability
(Required)
Add another liability?5
(Required)
Yes
No
Liability5
Liability (E.g. Edgars, Nedbank etc.)
(Required)
Type of Credit (E.g. Store card, credit card etc.)
(Required)
Total current value of your interest in the liability
(Required)
Add another liability?6
(Required)
Yes
No
Liability6
Liability (E.g. Edgars, Nedbank etc.)
(Required)
Type of Credit (E.g. Store card, credit card etc.)
(Required)
Total current value of your interest in the liability
(Required)
Hidden
D
Section E: Capital: Business Assets and/or Directorships (complete separately for each business asset and/or directorship)
Include details of all your business interests.
Documentation required for attachment to this section:
a) Copies of the business accounts (annual financial statements) for the last two financial years
b) Any documentation, if available at this stage, upon which you have based your estimate of the current value of your interest in this business, e.g. a letter from an accountant that is not a formal valuation. It is not essential to obtain a formal valuation at this stage.
Upload business account for the last two years
Drop files here or
Select files
Max. file size: 128 MB.
Upload documentation upon which you have based your estimate of the current value of your interest in the business
Max. file size: 128 MB.
Name and brief description of the business
(Required)
What do you operate as?
Please select one option
Are you a Sole trader/partner?
Sole trader/partner
Are you a Member in a close corporation
Close Corporation
Are you a Shareholder in a limited company?
Are you a Shareholder in a limited company
If you are a partner or a shareholder, state the extent of your interest in the business (i.e. partnership or the extent of your shareholding compared to the overall shares issued)
(Required)
Total amount of any sums owed to you by the business by way of a director’s loan account, partnership capital or current accounts or the like. Identify where these appear in the business accounts.
(Required)
Your estimate of the current value of your interest in the business. Explain briefly the basis upon which you have reached that figure.
(Required)
TOTAL value of all YOUR interests in business assets: E
Section F: Capital: Pension interests (complete separately for each pension interest)
Include details of all your interests, including retirement annuities, pension funds, preservation funds.
Documentation required for attachment to this section:
a) A recent statement showing the cash equivalent provided by the trustees or managers of each pension arrangement, alternatively, the value as prescribed in terms of the Divorce Act.
b) If a valuation is not available, give the estimated date when it will be available and attach a copy of your letter from the pension fund or administrators from whom the information was sought.
Upload a recent statement showing the cash equivalent provided by the trustees or managers of the pension arrangement
Drop files here or
Select files
Max. file size: 128 MB.
Name of pension interest
(Required)
Policy number of pension interest
(Required)
Type of scheme
(Required)
Value of this pension interest
Date the pension was calculated
(Required)
MM slash DD slash YYYY
Hidden
Total value of all your pension interests F
Add another pension interest? 2
(Required)
Yes
No
Pension interest 2
Name of pension interest
(Required)
Policy number of pension interest
(Required)
Type of scheme
(Required)
Value of pension interest 2
Date the pension was calculated
(Required)
MM slash DD slash YYYY
Add another pension interest?3
(Required)
Yes
No
Pension interest 3
Name of pension interest
(Required)
Policy number of pension interest
(Required)
Type of scheme
(Required)
Value of pension interest 3
Date the pension was calculated
(Required)
MM slash DD slash YYYY
Add another pension interest?4
(Required)
Yes
No
Pension interest 4
Name of pension interest
(Required)
Policy number of pension interest
(Required)
Type of scheme
(Required)
Value of pension interest 4
Date the pension was calculated
(Required)
MM slash DD slash YYYY
Section G: Capital: Other assets (complete separately for other asset in which you have an interest)
Give details of any other assets not listed previously. INCLUDE (the following list is not exhaustive):
Any personal or business assets not yet disclosed
Share option or incentive schemes (whether or not your shares have vested)
Business expansion schemes
Futures
Commodities
Any asset not disclosed elsewhere on this form even if held outside of South Africa
You are reminded of your obligations to disclose ALL your financial assets and interests of ANY nature.
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Type of asset
Value of asset
Total net value of interest
Hidden
Total G
Hidden
A+B+C+E+F+G
Hidden
A+B+C+E+F+G- D
Capital: founder, trustee or beneficiary of a Trust (complete separately for each trust in which you have an interest in)
Are you a founder, trustee or beneficiary of any Trusts? If so, please give the name, and IT number, and capacity in which you act.
Name of Trust
IT Number
Your capacity
Name of Trust
IT Number
Your capacity
Name of Trust
IT Number
Your capacity
Name of Trust
IT Number
Your capacity
Name of Trust
IT Number
Your capacity
Section H: Income: Earned income from employment (complete separately for each entity where you are employed)
Include details of earned income from employment.
Documentation required for attachment to this section:
a) IRP5 for the last financial year
b) Your last three payslips
Upload your IRP5 for the last financial year
Drop files here or
Select files
Max. file size: 128 MB.
Upload your last three payslips
Drop files here or
Select files
Max. file size: 128 MB.
Name of Employer
(Required)
Address of Employer
(Required)
Job Title
(Required)
Gross income for last financial year as shown on your IRP5
(Required)
Net income for last financial year i.e. gross income less income tax and UIF (do not deduct pension contributions)
(Required)
Details and value of any bonuses or other occasional payments that you have received from your employer over the past 24 months, if not reflected in your gross and net income above
(Required)
Details and values of any benefits in kind, perks or other remuneration received from The employer (e.g. Provision of a car, travel payments, accommodation, meal expenses)
(Required)
Your estimate of your net income from this employer for the next 12 months
(Required)
Estimated total of ALL net earned income from all employment Total H
Section I: Income: Investments (complete separately for each investment from which income is derived)
For example, dividends, interest, rental income etc. You will have already given details of your business and provided the last two years accounts in a previous section. Complete this section giving details of your income from your business.
Documentation required for attachment to this section:
a) A copy of your last tax assessment or, if that is not available, a letter from your accountant confirming your tax liability
b) If net income from the last financial year and estimated net income for the next 12 months is significantly different, a copy of management accounts for the period since your last account
Upload your tax assessment
Max. file size: 128 MB.
Upload a copy of your management account if your net income from the last financial year and your estimated net income for the next 12 months will be significantly different.
Max. file size: 128 MB.
Name of the business
Date to which your last account were completed
MM slash DD slash YYYY
Your share of gross business profit from the last completed accounts
Tax payable on your share of gross business profit above
Net income for that year (using the two figures directly above, gross business profits less tax payable)
Details and value of any dividends, benefits in kind, perks or other remuneration received from this business in the last year e.g. provision of a car, payment of travel, accommodation, meal expenses etc.
Amount of any regular monthly or other drawings that you take from this business
If the estimated figure directly below is different from the net income as at the end date of the last completed accounts, briefly explain the reason(s)
Your estimate of your net annual income for the next 12 months :I
Section J: Income: Self-employment, partnership or other assets/investments (complete separately for any partnership, self-employment or other asset/ investment from which income is derived
Details of income received in the last financial year, and your estimate of your income for the current financial year. Indicate whether the income was paid gross or net of income tax. You are not required to calculate any tax payable that may arise.
Nature of income and the asset from which it derives
(Required)
Paid gross or net
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add another nature of income?2
(Required)
Yes
No
Income 2
Nature of income and the asset from which it derives
(Required)
Paid gross or net
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add additional income? 3
Yes
No
Income 3
Nature of income and the asset from which it derives
(Required)
Paid gross or net
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add another income? 4
(Required)
Yes
No
Income 4
Nature of income and the asset from which it derives
(Required)
Paid gross or net
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add another income? 5
(Required)
Yes
No
Income 5
Nature of income and the asset from which it derives
(Required)
Paid gross or net
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add another income? 6
(Required)
Yes
No
Income 6
Nature of income and the asset from which it derives
(Required)
Paid gross or net
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Hidden
Total J
Section K: Income: State benefit (complete separately for each state benefit from which income is derived)
Details of all state benefits that you are currently receiving, including: State pension, child or disability benefit
Name of benefit
Amount Paid
Frequency of payment
Estimated income: next 12 months
Name of benefit
Amount Paid
Frequency of payment
Estimated income: next 12 months
Name of benefit
Amount Paid
Frequency of payment
Estimated income: next 12 months
Name of benefit
Amount Paid
Frequency of payment
Estimated income: next 12 months
Name of benefit
Amount Paid
Frequency of payment
Estimated income: next 12 months
Hidden
Total K
Section L: Income: Any other income (complete separately for all other income which you receive)
Details of any other income not disclosed previously.
INCLUDE:
Any source including a Pension OR Living Annuity
From which income has been received during the last 12 months (even if has not ceased)
From which income is likely to be received during the next 12 months
Nature of income
(Required)
Paid gross or net income
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add additional income?2
Yes
No
Income 2
Nature of income
(Required)
Paid gross or net income
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add additional income? 3
Yes
No
Income 3
Nature of income
(Required)
Paid gross or net income
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add additional income?4
Yes
No
Income 4
Nature of income
(Required)
Paid gross or net income
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Add additional income? 5
Yes
No
Income 5
Nature of income
(Required)
Paid gross or net income
(Required)
Income received in the last financial year
(Required)
Estimated income for the next 12 months
(Required)
Hidden
Total L
Hidden
L
Hidden
Total H-L
Maintenance Requirements (complete separately for yourself and your children)
Maintenance needs for yourself and for any children living with you or provided for by you. All figures should reflect your monthly requirements (not annual, termly or weekly) You must not use a combination of these periods.
Lodging (bond repayment, levy, rental, board)
Self
Lodging
Child/ren
Total Lodging
Food, Groceries & Cleaning Materials
Self
Groceries
Child/ren
Total Groceries
Toiletries
Self
Toiletries
Child/ren
Total Toiletries
Baby Food
Self
Baby Food
Child/ren
Total Baby Food
House Expenditure: Rates
Self
House Expenditure: Rates
Child/ren
House Expenditure: Rates Total
House Expenditure: Water
self
House Expenditure: Water
Child/ren
House Expenditure: Total
House Expenditure: Electricity/ Gas / Paraffin
Self
House Expenditure: Electricity / Gas / Paraffin
Child/ren
House Expenditure: Electricity / Gas / Paraffin: Total
House Expenditure: Household Insurance
Self
House Expenditure: Household Insurance
Child/ren
House Expenditure: Household Insurance Total
House Expenditure: House Owners Insurance
Self
House Expenditure: House Owners Insurance
Child/ren
House Expenditure: House Owners Insurance Total
Laundry / Dry Cleaning
Self
Laundry / Dry Cleaning
Child/ren
Laundry / Dry Cleaning
Lunches
Self
Lunches
Child/ren
Lunches
Telephone and ADSL
Self
Telephone and ADSL
Child/ren
Telephone and ADSL
Cell Phone
Self
Cell Phone
Child/ren
Cell Phone
Domestic Worker
Self
Domestic Worker
Child/ren
Domestic Worker
Gardener
Self
Gardener
Child/ren
Gardener
Plants
Self
Plants
Child/ren
Plants
Fresh Flowers
Self
Fresh Flowers
Child/ren
Fresh Flowers
Swimming Pool and Chemicals & Maintenance
Self
Swimming Pool and Chemicals & Maintenance
Child/ren
Swimming Pool and Chemicals & Maintenance
Clothing: Clothing and Shoes
Self
Clothing: Clothing and Shoes
Child/ren
Clothing: Clothing and Shoes
(Self)School Uniforms
Self
(Child/ren) School Uniforms
Child/ren
School Uniforms
(Self)Sporting Clothing
Self
(Child/ren) Sporting Clothing
Child/ren
Sporting Clothing
(Self) Personal Car: Hair Care (cuts, colours etc)
Self
(Child/ren) Personal Car: Hair Care (cuts, colours etc)
Child/ren
Personal Car: Hair Care (cuts, colours etc)
(Self) Cosmetics and Make-up
Self
(Child/ren) Cosmetics and Make-up
Child/ren
Cosmetics and Make-up
(Self) Car: Instalments
Self
(Child/ren) Car: Instalments
Child/ren
Car: Instalments
(Self) Maintenance (services, tyres, Brake pads, etc)
Self
(Child/ren) Maintenance (services, tyres, Brake pads, etc)
Child/ren
Maintenance (services, tyres, Brake pads, etc)
(Self) Fuel
Self
(Child/ren) Fuel
Child/ren
Fuel
(Self) Licenses
Self
(Child/ren) Licenses
Child/ren
Licenses
(Self) Insurance
Self
(Child/ren) Insurance
Child/ren
Insurance
(Self) Taxi
Self
(Child/ren) Taxi
Child/ren
Taxi
(Self) Parking (incl. parking attendants)
Self
(Child/ren) Parking (incl. parking attendants)
Child/ren
Parking (incl. parking attendants)
(Self) Other Transport expense
Self
(Child/ren) Other Transport expense
Child/ren
Other Transport expense
(Self) Educational Expenses: School Fees
Self
(Child/ren) Educational Expenses: School Fees
Child/ren
Educational Expenses: School Fees
(Self) After School Fees
Self
(Child/ren) After School Fees
Child/ren
After School Fees
(Self) Au Pair / Tutor
Self
(Child/ren) Au Pair / Tutor
Child/ren
Au Pair / Tutor
(Self) Creche / Day Care
Self
(Child/ren) Creche / Day Care
Child/ren
Creche / Day Care
(Self) Books
Self
(Child/ren) Books
Child/ren
Books
(Self) Stationery
Self
(Child/ren) Stationery
Child/ren
Stationery
(Self) Outings
Self
(Child/ren) Outings
Child/ren
Outings
(Self) Sports
Self
(Child/ren) Sports
Child/ren
Sports
(Self) Extramurals
Self
(Child/ren) Extramurals
Child/ren
Extramurals
(Self) Other Educational Expenditure
Self
(Child/ren) Other Educational Expenditure
Child/ren
Other Educational Expenditure
(Self) Medical Expenditure: Medial Aid
Self
(Child/ren) Medical Expenditure: Medial Aid
Child/ren
Medical Expenditure: Medial Aid
(Self) Doctor / Dentist / etc. (excess)
Self
(Child/ren) Doctor / Dentist / etc. (excess)
Child/ren
Doctor / Dentist / etc. (excess)
(Self) Medication (excess)
Self
(Child/ren) Medication (excess)
Child/ren
Medication (excess)
(Self) Hospital
Self
(Child/ren) Hospital
Child/ren
Hospital
(Self) Insurance: Life
Self
(Child/ren) Insurance: Life
Child/ren
Insurance: Life
(Self) Retirement Annuity
Self
(Child/ren) Retirement Annuity
Child/ren
Retirement Annuity
(Self) Other Policies
(Children) Other Policies
Other Policies
(Self) Pocket Money / Allowances
Self
(Child/ren) Pocket Money / Allowances
Child/ren
Pocket Money / Allowances
(Self) Holidays
Self
(Child/ren) Holidays
Child/ren
Holidays
(Self) House Maintenance (plumber, handyman, electrician, painter)
Self
(Child/ren) House Maintenance (plumber, handyman, electrician, painter)
Child/ren
House Maintenance (plumber, handyman, electrician, painter)
(Self) Repair & Replacement of items: Household Appliances
Self
(Child/ren) Repair & Replacement of items: Household Appliances
Child/ren
Repair & Replacement of items: Household Appliances
(Self) Kitchenware
Self
(Child/ren) Kitchenware
Child/ren
Kitchenware
(Self) Linen, Towels, etc
(Child/ren) Linen, Towels, etc
Linen, Towels, etc
(Self) Other items
Self
(Child/ren) Other items
Child/ren
Other items
(Self) M-Net / DSTV
Self
(Child/ren) M-Net / DSTV
Child/ren
M-Net / DSTV
(Self) Entertainment & Recreation
Self
(Child/ren) Entertainment & Recreation
Child/ren
Entertainment & Recreation
(Self) Personal Loans
Self
(Child/ren) Personal Loans
Child/ren
Personal Loans
(Self) Security Alarm System
Self
(Child/ren) Security Alarm System
Child/ren
Security Alarm System
(Self) Membership Fees
Self
(Child/ren) Membership Fees
Child/ren
Membership Fees
(Self) Religious Contributions
Self
Religious Contributions
Child/ren
Religious Contributions
(Self) Charities
Self
(Child/ren) Charities
Child/ren
Charities
(Self) Gifts
Self
(Child/ren) Gifts
Child/ren
Gifts
(Self) TV Licence
Self
(Child/ren) TV Licence
Child/ren
TV Licence
(Self) Reading Material: Books
Self
(Child/ren) Reading Material: Books
Child/ren
Reading Material: Books
(Self) Newspapers
Self
(Child/ren) Newspapers
Child/ren
Newspapers
(Self) Periodicals / Magazines
Self
(Child/ren) Periodicals / Magazines
Child/ren
Periodicals / Magazines
(Self) Instalments for Credit / HP Agreements
Self
(Child/ren) Instalments for Credit / HP Agreements
Child/ren
Instalments for Credit / HP Agreements
(Self) (Furniture and Appliances)
Self
(Child/ren) (Furniture and Appliances)
Child/ren
(Furniture and Appliances)
(Self) Pets: Food
Self
(Child/ren) Pets: Food
Child/ren
Pets: Food
(Self) Pets: Vet
(Child/ren) Pets: Vet
Pets: Vet
(Self) Other (not specified)
(Child/ren) Other (not specified)
Other (not specified)
(Self) Total Expenditure
Self
(Child/ren) Total Expenditure
Child/ren
Total Expenditure
Hidden
Total Expenditure
Other information
Details of any significant changes in your assets or income. At both section sub-headings below, INCLUDE:
ALL assets held both within and outside South Africa
The disposal of any asset
Significant changes in assets or income during the LAST 12 months.
(Required)
Significant changes in assets or income likely to occur during the NEXT 12 months.
(Required)
Standard of living enjoyed by you and your spouse during the marriage Include details of the types of vehicles you both drive, if any, the destinations of your last three family holidays, how often you eat our at restaurants, which shops you buy your groceries at, etc.
Briefly provide details of the standard of living enjoyed by you and your spouse during the marriage
(Required)
Are there any particular contributions to the family property and assets or outgoings, or to family life, or the welfare of the family that have been made by you, your partner or anyone else that you think should be taken into account? If there are any such items, briefly describe the contribution and state the amount, when it was made and by whom
INCLUDE:
Contributions already made
Contributions that will be made in the foreseeable future
Briefly provide details of any particular contributions made or to be made to the family property or assets as described above
(Required)
Bad behaviour or conduct by the other party will only be taken into account in the most exceptional circumstances. If you feel it should be taken into account in your case, identify the nature of the behaviour or conduct below.
Identify and describe the nature of the bad bahviour or the conduct by the other party that you feel should be taken into account.
(Required)
Other circumstances that could significantly affect this matter INCLUDE (the following list is not exhaustive):
Earning capacity, or limits thereon
Disability
Inheritance prospects
Retrenchment
Retirement
Any agreement made between you and your spouse before or after your marriage, stating whether or not you rely upon the agreement giving your reasons
Any plans to marry, form a civil union or live with a new life partner
Any contingent liabilities
Provide details of any other circumstances that you consider could significantly affect this matter.
(Required)
Declaration/ Affirmation
Proceedings for contempt of court may be brought against a person who makes or causes to be made, a false statement in a document under oath or affirmation
I hereby declare under oath/ hereby truly affirm that to the best of my knowledge and belief the aforementioned statements are true, complete and correct.
(Required)
Do you know and understand the contents of the above declaration?
(Required)
Yes
No
Do you have any objection to taking the prescribed oath?
(Required)
Yes
No
Do you consider the prescribed oath to be binding on your conscience?
(Required)
Yes
No
Date of acceptance
(Required)
MM slash DD slash YYYY
Signature
Commissioner of Oaths - FOR OFFICE USE ONLY
Hidden
I hereby certify that the deponent has acknowledged that he knows and understands the contents of this declaration, which was sworn to/affirmed* before me, and the deponent’s signature was placed thereon in my presence.