Acknowledgement of Debt (South Africa)

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ACKNOWLEDGEMENT OF DEBT

Signed at __________ on this ___ day of _______, 20___.

We, the undersigned,

1. _______________________________________

2. _______________________________________ (hereinafter, "the Debtors")

jointly and severally, hereby acknowledge that I we are liable to _______________________________________ (hereinafter, the "Creditor") in the sum of R ___________________ (hereinafter, "the Debt")

and undertake to pay to the order of the Creditor the Debt together with interest at the rate of ______ % per annum (hereinafter, "the Interest") from the ___________, 20__, to __________, 20__, subject to the following terms:

1. The full Debt together with the Interest shall be due and payable to the Creditor on ___________, 20__, at ________________________________________ free of bank charges and commission.

2. In the event of default, the Debtors shall be liable, jointly and severally, for all legal costs incurred in the collection of the outstanding balance, plus interest at the rate of ________% per annum. Interest shall be calculated on the same day of each month, in arrears, on the outstanding balance until the total amount due has been paid.

3. The Debtors hereby choose as our domicilium citandi et executandi the following address:

______________________________________________.

4. The Debtors hereby consent to the jurisdiction of the Magistrate's Court having jurisdiction in connection with all legal proceedings arising from this letter.

5. The Debtors renounce the benefits of the legal exceptions non numeratae pecuniae, non causa debiti, error calculi, division and revision of accounts. The Debtors acknowledge that I we are fully aware of the meaning and effect of such renunciations.

6. The Creditor may cede or pledge its rights herein without The Debtors' consent.

7. The Debtors may pay any portion of the Debt plus interest before the due date without derogating from any right the Debtors may have in these terms.

8. The Debt plus interest will become due and payable immediately on a provisional order of insolvency of the Debtors.

______________________________        ______________________________

(the Debtors)

Witnesses:

1.                                                                       

2.                                                                                      

______________________________

(the Creditor)

Witnesses:

1.                                                                       

2.