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Application for permitted financial services
Permitted financial services and dealing with property in terms of section 26C of the FIC Act
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Applicant FullName
Email Address
Contact Number
Person/Entity on Consolidated List of Targeted Financial Sanctions pursuant to section 26A of the Financial Intelligence Centre Act, 2001
Relations to person/entity
Institutions holding assets
Please enter required amount in ZAR
Food Stuffs
Rent or Mortgage
Medicine or Medical Treatment
Taxes
Insurance Premiums
Public Utility Charges
Maintenance Order
Reasonable Professional Fees
Reimbursement of expenses associated with provision of legal services
Satisfy Judgment or arbitral award
Payment to a third party due under contract
Accrue interest or other earnings due on accounts
Payment due to a person or entity affected by a prohibition
Other Expense
Other Expense Total
Total Amount Required
Obligatory Supporting Documentation to accompany this application
1. A copy of the Applicants Identity Document or Passport
2. A declaration by an affidavit declaring:
a) the applicant's interest in the property;
b) all the applicant's assets and liabilities; and
c) that the applicant cannot meet the expenses out of property not subject to section 26B.
If the applicant is a third party, the following document must accompany this application -
1. Copy of judgment, award, contract or agreement, as may be applicable
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