I/we wish to apply for a variation of the above loan contract on the grounds of hardship under section 72 of the National Credit Code.

Change requested

I/we request the following change to my/our contract: (Please choose one)

I/ we assume that you will not continue to charge default fees, default interest or make an adverse listing on my/our credit report while my/our hardship request is being considered.

Supporting information

I/we confirm that my/our financial hardship was caused by:
illness, unemployment or other reasonable cause. Give brief details:

I/we will be able to repay the loan if the requested variation is granted because (Please choose one)

Please send me/us a Financial Statement of Position to complete, if required.

I/we await your reply in writing within 7 days of the date of this letter.