Load Tenancy Debt

Fields marked * are mandatory fields

You can download this form here and email it to admin@cia.nz if you have trouble with this online form.

YOUR DETAILS
First Name*		Surname*
Address*		Email*
Phone Number*		Mobile Number
Company
Trading As
Bank Number*	- - - (For debtor payments to be paid into)	Your Reference
illion Tenancy member ID	(Only required if you are an illion Tenancy member)

DEBTOR DETAILS
First Name*		Surname*
Middle Name		Gender*
Tenancy Address (where the debt occurred)*
Date of Birth	(Enter in as XX/XX/XXXX format)	Email
Are they on a WINZ benefit?*		WINZ Number
Phone Number 1		Employer
Phone Number 2		Employers Phone
Debtor's current address Debtor's previous addresses		Other information that may be of help collecting the debt i.e debtor's relatives contact details
Upload a photo of the debtor

DEBTOR 2 DETAILS
First Name*		Surname*
Middle Name		Gender*
Tenancy Address (where the debt occurred)*
Date of Birth	(Enter in as XX/XX/XXXX format)	Email
Are they on a WINZ benefit?*		WINZ Number
Phone Number 1		Employer
Phone Number 2		Employers Phone
Debtor's current address Debtor's previous addresses		Other information that may be of help collecting the debt i.e debtor's relatives contact details
Upload a photo of the debtor

DEBTOR 3 DETAILS
First Name*		Surname*
Middle Name		Gender*
Tenancy Address (where the debt occurred)*
Date of Birth	(Enter in as XX/XX/XXXX format)	Email
Are they on a WINZ benefit?*		WINZ Number
Phone Number 1		Employer
Phone Number 2		Employers Phone
Debtor's current address Debtor's previous addresses		Other information that may be of help collecting the debt i.e debtor's relatives contact details
Upload a photo of the debtor

DEBT DETAILS

Amount Owing $*

Tribunal Order Number

Date Incurred/Invoice Date* (Enter in as XX/XX/XXXX format)

Does your tenancy agreement have a debt collection clause *

Upload Tribunal order

Upload other docs

Have you previously enforced this debt via the District Court?*

District Court policy requires you to confirm CIA Debt Recovery is your enforcement agent acting on your behalf. Download this authorisation to act on behalf form here . Send the completed form to admin@cia.nz

If you have previously start any Court action on this debt or paid any Court fee's towards this debt, please state what was applied for, the fee/s you paid, and the Court enforcement application numbers (if any). This will help us to ensure we recover all that is owed to you.

If you have additional photo's, documents, Court orders etc, please email them directly to us at admin@cia.nz

*Click here to view Pricing Options

I have read and understood CIA Debt Recovery's full Terms of Engagement*

By accepting these terms, you agree to authorise CIA Debt Recovery Ltd to act as your agent in the above matters and agree to make payment of all charges and costs in accordance with the Terms of Engagement.

You agree to not proceed to legal action, nor take independent action by another means through an agency or, on your own accord, against this debtor without first consulting CIA Debt Recovery Ltd.

If you do take independent action or/and if any monies are paid to you or your agent, by the debtor, CIA Debt Recovery Ltd will invoice you for the full commission that relates to the option you have chosen above and any subsequent enforcement costs.

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