About This Financial Health Check

Welcome to your SalarySaver Financial Health Check. The starting point of your personalised financial wellness journey.

This is not a loan application.

It’s a 360° assessment that helps us understand your full financial picture so we can identify:

• Hidden overcharges
• Expensive loans draining your salary
• Overpriced funeral policies
• Old debts you may no longer need to pay
• Cashflow leaks and opportunities for relief
• Where coaching, consolidation or zero-cost support is best for you

Before we recommend any solution,
we diagnose your financial health.

Please upload:

• Latest payslip
• 3-month bank statement
• Funeral/insurance policy schedules for savings checks

Personal Information

Full Name: ID Number: Contact Number: Email Address: Confirm Email Address:

Please re-enter your email address to confirm it matches.

Residential Address:

Financial Information

Accommodation & Utilities (R): Household & Living Costs (R): Other Commitments (R): Transport (R): Interested in zero fees, no interest emergency cash assistance? Yes No

Check Your Insurance for Hidden Overcharges

Most employees pay too much for retail funeral and credit-life insurance — often without knowing. Upload your policy schedule and we will:

• Identify hidden overcharges
• Match or improve your cover
• Reduce premiums by 30–70%
• Waive waiting periods where they’ve already been served

This is a free review as part of your financial diagnosis.
No obligations. No product push.

Are you a smoker? Please select Yes No What is your highest level of education? Please select Matric / Grade 12 Certificate / Diploma Bachelor’s Degree Honours Master’s Doctorate Other

Free Will Drafting (Included in the Programme)

SalarySaver includes a complimentary basic will to help you protect your family.

If you capture your beneficiary details here, our team will contact you to finalise your will at no cost.

Capture Will Beneficiaries

Supporting Documents

Upload Latest Payslip:

Attach your most recent payslip.

Upload 3-Month Bank Statement:

Attach your latest 3-month bank statement.

Upload Your Funeral Insurance Policy Schedule (for replacement quote):

Optional — attach your existing insurance policy schedule if you want a replacement quote.

Your Salary Saver Goals

What are you hoping to get out of Salary Saver? Please give us a summary.

0/600 characters

Declaration by Applicant

I, the undersigned, declare that the information provided above is true and correct. I consent to Empower FS (Pty) Ltd conducting affordability assessments and credit bureau checks in accordance with the National Credit Act.

Signature (type your full name): Date: