GemachSA Loan Application Form

GemachSA Loan Application Form

in association with the Rambam Charitable Trust. (This form will take just a few minutes to complete, please ensure that you have your ID/Passport and Payslip/Bank Statement ready to upload at the end of the form. )
Full Name*

First NameSurname
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What shul to you attend?*
Are you currently receiving any financial assistance from the Chevra Kadisha or another Jewish welfare source? (If yes, please detail)*
Do you understand and acknowledge that this is an interest free loan which needs to be repaid within 6 months?*
Are you in a position to repay the loan? *
How do you plan to ensure that you can pay back your loan? *
Name and cell number of a 3rd party reference (can be employer):*

Loan Acknowledgement of Debt

I,    First Name   Last Name (“debtor”),

with ID / Passport Number

hereby acknowledge that I am truly and lawfully indebted unto and in favour of the Rambam Charitable Trust (Reg. Trust 5367/95 PBO 18/11/13/2339 NPO Reg. 035-622) (“creditor”) in the amount of



Being in respect of monies lent and advanced to me on or about

Date*   (“the loan date”)

The debtor warrants that such funds will be used ONLY for the purchase of food, perishables and clothing for Yom Tov or towards an airline ticket to be used for a child attending yeshiva/seminary.

The debtor undertakes to repay the above amount, free of interest in 6 equal monthly instalments, the first repayment is due on the first day of the full calendar month following the loan date.

In the event of any one payment not being made on due date, the full balance then outstanding shall immediately become due, owing and payable.

The debtor confirms that this acknowledgement of debt shall not be construed as a promissory note in terms of Section 87 of the Bills Exchange Act, No 34 of 1964. There shall be no variation or amendment to this Acknowledgment of Debt, unless reduced to writing and signed by the creditor and the debtor.

In the event of any dispute arising from this Acknowledgement of Debt, the debtor hereby consents to the Beth Din of Johannesburg being the sole arbitrator in such dispute and accepts that the Beth Din’s decision shall be final and binding. The aforegoing is without prejudice to the creditor’s rights to enforce compliance with the debtor’s obligation/s to make payment in terms of this acknowledgement of debt in the appropriate Civil Court.

The debtor acknowledges and agrees that this digitally signed version of this Acknowledgment of Debt shall be binding.

The debtor chooses his/her Domiclium Citandi Et Executandi as

Enter home address*

The debtor hereby authorises the creditor to debit his/her account on the 1^st working day of each month following the loan date with 6 equal installments of the amount borrowed paid to the creditor in full. (This will be the same account that the funds will be paid into):

BANK ACCOUNT OF DEBTOR
Bank*
Branch / Branch Code*
Account Number*

Date*

Funds are limited and are not guaranteed. Terms and conditions apply
Signature

Clear

Please upload your ID / Passport*

Cancelof
Please upload your recent payslip / bank statement*

Cancelof
Should be Empty:

GemachSA Loan Application Form

Loan Acknowledgement of Debt

Date*