Section 15 and 16

National Credit Regulator
FORM 39 STATISTICAL RETURN
1	Name of Registered Entity
2	NCR Registration Number
3	Start of reporting period			dd/mm/yyyy
4	End of reporting period			dd/mm/yyyy
5	Name of person that completed this form
6	E-Mail
7	Contact telephone number			Code		Number
15. Pawn Transactions
15.1 Value and Volume - Pawn transactions during period
						Number	Rand Value
Pawn agreements entered into during reporting period
Pawn agreements entered into with HDPs (Black, Coloured & Indian)
Pawn agreements with women
Pawn agreements with men
Pawn agreements with persons residing in low density areas
15.2 Indicate percentage distribution amongst different types of goods pawned
			Electronic Goods	Cell phones	Jewellery	Elect./ Mech. Tools	White goods	Bicycles
Percentage
			Toys	Livestock	Other			Total
Percentage								100%
15.3 Purpose for which money is used  by client
			To pay off debt	School or Education fees	For living: Rent, Food transport etc	Emergency See below	Other	Total
Rand Value
Number
Emergency loans analysis
			Death and Funeral	Medical and Illness	Interruption of Income	Loss: theft or fire etc	Other Emergency	Total
Rand Value
Number
Section 16:   Summary of Debtors (Pawn) Book
					Pre NCA		NCA Book
Gross Value of Debtors Book at period end (Excl. unearned)
Minus: Provision for doubtful debt on last day of period
Equals: Net Value of Debtors Book on last day of period
Number of accounts that make up the debtors book
Rand Value of write-offs during period
Number of accounts written-off during period
Analysis of agreements for which payment was not received
No payment received					Rescheduled
Number of agreements			Rand Value outstanding		Number of agreements		Rand Value Outstanding