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Ph: 0800 111 007

Upload Your Tenancy Debt

Names of Debtor (ex tenant):
Known Aliases of Debtor:
Company Name (If applicable):
Your reference for this debt:
Gender:
Date of Birth:
Debtor's email address:
Debtor's photo ID:
Photo ID Version (if applicable):

Current home address of debtor:
Suburb:
Town / City
Current home phone:

Company Name:
Work address:
Suburb:
Town/City:
Occupation:
Work Phone:
Mobile Phone:
Car Reg. No.:
WINZ#:

Names of Debtor 2:
Known Aliases of Debtor:
Company Name (If applicable):
Your reference for this debt:
Gender:
Date of Birth:
Debtor's email address:
Debtor's photo ID:
Photo ID Version (if applicable):

Current home address of debtor:
Suburb:
Town / City
Current home phone:

Company Name:
Work address:
Suburb:
Town/City:
Occupation:
Work Phone:
Mobile Phone:
Car Reg. No.:
WINZ#:


Any other helpful details:
Description of tenant 1 (e.g. 5’10” tall, tattoos, distinguishing features
Upload Photo:

Please itemise these details – Please attach a copy of your Court Order and any application forms you got the debtor to complete – if any amount is not on a Tenancy or Disputes Tribunal order we may not be able to collect it.
Details	$	Amount (numbers only, no words)
	$
	$
	$
	$
	$
	$
	$
	$
	$
Subtotal:	$
Less Bond:	$
Less other credit/paid since Court order:	$
Total to recover:	$

OUR SPECIFIC INSTRUCTIONS


Our Details
Email Address:
My Company/Name:		*Mandatory Field
Postal Address:		(If you have already instructed us before, please only enter details that have changed.)
Suburb:
Town / City
Post Code:
Physical address:
Suburb:
Town / City
Post Code:
Contact person:
Phone:
Mobile Phone:
Fax:
Position:

My bank account number for direct credit of any proceeds of recovery:
My chosen billing option is:	Fee schedules

I/We authorise The C.I.A. Debt Recovery Group Ltd to act as our agents in the above matters and agree to make payment of all charges and costs in accordance with The C.I.A. Debt Recovery Group Ltd current terms and conditions. I/We agree to not proceed to legal action, nor take independent action by any other means through agency or on my/our own accord, against this debtor without first notifying The C.I.A. Debt Recovery Group Ltd. If I/we do take independent action, I/we know we will be liable and be invoiced for the whole commission that relates to the option I have chosen above and any subsequent enforcement costs.
We understand and agree to these terms

Please attach any supporting documentation. Please note we will formally acknowledge your instructions, after assigning this debt a reference number, by email
Upload Files: