Greetings, Matjhabeng!

• 1.1 The usage of the property must predominantly be for private residential purposes.
• 1.1 b) The total household income must not exceed the joined pensions of the two (2) state pensioners as determined by the state in the National Budget.
• The following grants received will be excluded from determining household income:
  • Foster Child Grant
  • Child Support Grant
  • Care Dependency Grant
• 1.2 a) The applicant must not be the registered owner of more than one property.
• 2. Who does NOT qualify?
  • Any household where the combined gross income of all occupants/residents exceed joint pension of two state pensioners per month.

The account holder must apply in person and must present the following documents upon application:

The undersigned who resides at the address indicated above, hereby apply for the Household Indigence Subsidy determined in relation to income indicated above, and solemnly declare that:

• a) All the particulars furnished in this form, including the total gross income of myself and all occupants of the premises, are to the best of my knowledge and belief true and correct.
• b) If the particulars furnished in this form should change for any reason, I would immediately notify Council.
• c) I am aware that the information supplied in this form by me will be made available by Council to the Credit Bureau.
• d) I or any other occupant do not own any other property in the Republic of South Africa apart from the property indicated on the account for which this application is made.
• e) I agree that Council Officials may conduct an on-site audit to verify the information supplied on this declaration.
• f) I am aware that any false declaration on this form is punishable by law and will result in disqualification of the subsidy.
• g) I agree that the supply of water to my premises may be restricted by a flow control washer and/or any other method Council may deem fit.
• h) I do hereby acknowledge that the debts in respect of the arrears to R_________________ (Amount) as at ____ / ____ / ______ (date) (Together with interest accrued at the Standard Bank Interest Rate) on the account number indicated, remains payable by me.
• i) This application is signed under oath.

The Matjhabeng Municipality has decided to implement relief for households with minimal or no income with effect from 1 July 2002. This application form, together with the documents/forms indicated below, must be brought by the account holder (i.e. the person in whose name the account is rendered) to one of the Council Offices indicated on the pamphlet enclosed.

• 3. Documentary proof of income (e.g. a letter from an employer, salary advice, pension card, UIF card, etc.) must be presented in order to qualify for a subsidy.
• 4. In addition, applicants will be required to sign and submit a sworn affidavit, to the effect that all information supplied is true and that all income, i.e. from formal and/or informal sources, is declared.
• 5. Council reserves the right to send officials to premises/households receiving relief, for the purpose of conducting an in-site audit of the details supplied.
• 6. The account holder must apply in person and must present the following documents upon application:
  • Details of the account holder
  • Proof of residence (Municipal Account)
  • Identification documents
  • Electricity Meter Number
  • Copy of three months latest Bank Statements (Where applicable)
  • An application form (on reverse side) indicating the names and identity numbers of all occupants/residents over the age of 18 years, who resides at the property.
  • If property owner is deceased, a certified copy of death certificate and/or letter of appointment must be produced.
• 7. If application is approved, the assistance will be with no guarantee of renewal, as it is funded by a grant from National Government. The onus is on account holders to reapply for relief each year, failing which the assistance will cease automatically.
• 8. The services which will qualify for assistance together with the percentage relief per service, is indicated on the pamphlet enclosed.