REVENUE DEPARTMENT:

CIVIC CENTRE
12 HERTZOG
BOULEVARD
PO BOX 655
CAPE TOWN
8000
APPLICATION FOR INDIGENT SUPPORT (R4 500 OR LESS PER MONTH)

2019-2020

PLEASE ANSWER THE FOLLOWING QUESTIONS BEFORE APPLYING FOR INDIGENT SUPPORT:

NO QUESTIONS Yes No

1 Are your municipal payments behind?

If you answered ‘No’ to Question 1, you may apply for indigent support – please go to Page 2 of this
form.

If you answered ‘Yes’ to Question 1, please continue to Question 2.

Has any of the money owing on this municipal account been written off after 1 July
2 2009 in terms of the indigent provisions contained in the Credit Control and Debt
Collection Policy?
If you answered ‘No’ to Question 2, you may apply for indigent support – please go to Page 2 of this
form.

If you answered ‘Yes’ to Question 2, please continue to Question 3.

3 Did you make an arrangement to pay off the money you owe the municipality?

If you answered ‘No’ to Question 3 then you must make an arrangement to pay the money owing
BEFORE you may apply for indigent support.
If you replied ’Yes’ to Question 3, you may apply for indigent support – please go to Page 2 of this
form.

Page 1 of 8
DECLARATION BY OWNER(S) OR APPLICANT(S)

To: City of Cape Town

Civic Centre
12 Hertzog Boulevard
CAPE TOWN
8000

Attention: Director: Revenue

I/we, the undersigned (insert your full name or names here),

hereby apply for indigent support in terms of the Council’s Credit Control and Debt Collection Policy.

The questions that follow refer to all of the names listed above.

All the people whose names are listed above must now answer all the questions in Part D on Page 7 of this
form. Part D is also part of this declaration/affirmation. At least one person must answer ‘Yes’ to at least one
question in Part D, or you may not continue with this application.

If you have answered ‘Yes’ to at least one question in Part D, then you may continue with Part A.
PART A

NO QUESTION YES NO

A1 If the property is also used for business, is 60% or more of the property used as a
private residence?
A2 Is the income R4 500 or less per month?
(This income refers to the monthly household income before any deductions, of
both the owner and spouse or partner including any party in a cohabitation
relationship from all sources, including but not limited to salaries, wages, dividends,
pensions, grants, rentals, board and lodging, interest received, and any investment
income)
A3 Do you own only one immovable property, in South Africa or elsewhere?

A4 Are you a full-time occupant of the property?

A5 If you are receiving an electricity supply from the City of Cape Town and you do
NOT have a prepayment meter installed, have you applied for the installation of a
prepayment meter?
A6 If you do NOT have a water management device installed, do you agree to the
installation of such a water management device, so as to reduce your
consumption to affordable levels?

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 PART B

Please fill in the following details.

Property details:

Municipal account number for the

property

Erf number

Address of property

Your details:

Surname

Name(s)

Date of birth

Residential address

Postal address

Identity number

Home telephone number

Cellphone number

Name of employer

Employer’s address

Work telephone number

Spouse’s details:

Surname

Name(s)

Date of birth

Page 3 of 8
Residential address

Postal address

Identity number

Home telephone number

Cellphone number

Name of employer

Employer’s address

Work telephone number

PART C

Question Number Question Yes No

C1 Are you married or living with a partner?

Are you or your spouse or partner a member, director

C2 and/or partner in any, inter alia, business organisation,
corporate entity, partnership or firm?
If you replied ’Yes’ to Question C2, please complete the
next row
Name of the business
organisation, corporate
entity, partnership or firm

Registration number

 You must submit a certified copy of the registration documents of the business organisation,
corporate entity, partnership or firm with this application
 Provide any income derived from the business organisation, corporate entity, partnership or firm in
the table immediately below

Page 4 of 8
Details of the owner of the property for which this application is being made, as well as his/her spouse or
partner:

Proof of
Employ-ed
Gross income
Relation-ship
Initials and monthly Source of
to account ID number
surname income income
holder Yes No Yes No
R

Total of gross monthly income

You must submit certified copies of the following documents with this application:

If you are employed –

 Proof of identity (such as your ID book)

 Latest salary/wage payslip, or a letter from an employer confirming your income
 If you are self-employed, a sworn affidavit stating how much you earn per month
 Proof that you receive a disability grant or pension
 A bank statement for the last three months or a sworn affidavit confirming that you do not have a
bank account
 A bond statement for the last three months or a sworn affidavit declaring that you do not have a
bond account

If you are unemployed –

 Proof of identity (such as your ID book)

 A sworn affidavit confirming that you are unemployed
 A sworn affidavit that you have no other source of income
 A bank statement for the last three months or a sworn affidavit confirming that you do not have a
bank account
 A bond statement for the last three months or a sworn affidavit declaring that you do not have a
bond account

Deceased estates: please provide the following certified documents

 Letter of executorship from the Master’s Office; or

 A will registered and accepted by the Master’s Office; or
 A next-of-kin affidavit from the Master’s Office.

Page 5 of 8
Declaration

This must be signed by:

 the owner(s) as well as their spouse or partner, or
 the applicant(s)

a) I do not own any other immovable property either in South Africa or elsewhere.
b) I will immediately inform the Director: Revenue, in writing, of any change in my status that disqualifies
me from being indigent.
c) I agree that if I have lied about my qualifying criteria in order to benefit from Council’s indigent relief,
I will have committed an offence, and all indigent relief benefits that I have received, will be taken
back. I will be subject to normal debt collection procedures.
d) To the best of my knowledge, all the information that I have submitted in this application is true and
correct.
e) I understand that if my monthly water consumption is greater than the free allocation of water and I
do not pay for my additional consumption, my supply may be restricted. I will then only have access
to my free allocation of water.
f) Council may conduct an investigation to confirm any information I have given and I hereby agree
to any on-site visit by any municipal official.
g) I accept that if this application is successful, it will only be valid for 12 months from the date of
approval, and it is up to me to re-apply before the expiry date; or

(i) I accept that because I am 60 years or older, that my application if successful, will only be valid
until the next General Valuation or Supplementary Valuation are implemented, and it is up to me to
re-apply before the expiry date. Council will also suspend any debt collection action for this period,
or until I no longer qualify as indigent, whichever happens first.
h) I acknowledge that if my application is successful, Council will suspend any debt collection action
for 12 months from the date of approval, or until I no longer qualify as indigent, whichever happens
first.
i) This application will be subject to the terms and conditions of Council’s Credit Control and Debt
Collection By-law and Policy.

Signature of applicant(s) Date

Page 6 of 8
FOR OFFICE USE ONLY

OFFICIAL’S FULL NAME (print) DATE SIGNATURE

All information and

documentation
supplied
Approval by
authorised official of
Debt Management
Authorised by
supervisor
Not approved

If not approved:
reasons must be
supplied

PART D

No Question Yes No
D1.1 Are you the registered owner of the property?
D1.2 Are you living in a child-headed household registered in the name of your
deceased parent(s)? (Certified copy of the death certificate of the
parent(s) to be provided in addition to the other required documents)
D1.3 Are you a purchaser of a residential property from any department of
Government on a delayed transfer basis?
D1.4 Did you get the property out of a divorce by a court order? (Certified
copy of the court order to be provided in addition to the other required
documents)
D1.5 Do you live on a property where a deceased estate has not been wound
up? (Certified copies of the death certificate, letter of executorship and
will to be provided in addition to the other required documents) If you
are, then answer the following questions:
D1.5a Was the property left to you after someone died?
D1.5b If you were married in community of property, are you the sole heir to a
property registered in both your name and that of your deceased spouse?
D1.5c If you were married in community of property, are you one of the heirs to a
property registered in the name of your deceased spouse?
D1.5d If only a portion of a property is registered in the name of the deceased,
are you the surviving registered owner, together with other heirs?
D1.5e If only a portion of a property is registered in the name of the deceased,
are you one of the surviving registered owners, together with other heirs?
D2 If the residential property is registered in the name of a trust, are you
currently a member of the trust? (Certified copy of the trust document to
be provided in addition to the other required documents)
D3 Were you granted the right to use the property for the rest of your life, in
other words are you a usufructuary of this property? (Certified copy of
proof to be provided in addition to the other required documents)
D4 Are you the spouse or minor child of the registered owner, who cannot
occupy the property due to no fault of his or her own? (Certified copy of
proof to be provided in addition to the other required documents)

NOTE! The names of ALL the people living at a residential property who meet any of the criteria set out
above must be added to Page 2 of this application form.

If you have answered ‘Yes’ to any of the questions in Part D, you may continue with the application process
by going to Part A on Page 2 of this form.

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