Request a payment plan form

To assist us in reviewing your matter, please provide the details requested below.  Please ensure that your contact details are correct as, if we can’t contact you, we will be unable to advise you of our client’s response and therefore won’t be able to enter into a payment arrangement with you.  If you would like to discuss alternative payment options, please contact us on  the number provided to you .

Fields marked * are mandatory fields
You can download this form here and email it to if you have trouble with this online form.

First Name*

Debt Number*

Last Name*

Date of Birth*

Email Address*

Phone Number*

Your Company  



Total Amount Owing $ *                                          

Proposed Payment Term*          

Payment Amount *                        

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


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  

   Click here to view Pricing Options

I have read and understood CIA Debt Recovery's  terms and conditions *

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 and conditions.

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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