Upload 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

Company Name:

Full Name*:

 Contact Person:

Email:

Phone No*:

Address*:

Your bank account number (for direct credits)*: - -  -  

Your Reference*:

TINZ member ID number: 
DEBTORS DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Address of Tenancy (where the debt occurred)*:

Date of Birth:

 Email:   

Are they on WINZ?*:

   WINZ Number:
Mobile Phone No:    Phone No:

Employer:

 Employers Phone No.

Debtor's current address:

Debtor's previous addresses

Any other information that may be of help collecting the debt

i.e debtor's relatives contact details:

Upload photo of debtor:

    
DEBTORS DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Address of Tenancy (where the debt occurred)*:

Date of Birth:

 Email:   

Are they on WINZ?*:

   WINZ Number:
Mobile Phone No:    Phone No:

Employer:

 Employers Phone No.

 

Debtor's current or previous address/es:

Debtor's previous addresses

Any other information that maybe of help collecting the debt

i.e debtors relatives contact details:
DEBTORS DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Address of Tenancy (where the debt occurred)*:

Date of Birth:

 Email:   

Are they on WINZ?*:

   WINZ Number:
Mobile Phone No:    Phone No:

Employer:

 Employers Phone No.

 

Debtor's current or previous address/es:

Debtor's previous addresses

Any other information that maybe of help collecting the debt

i.e debtors relatives contact details:
DEBTORS DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Address of Tenancy (where the debt occurred)*:

Date of Birth:

 Email:   

Are they on WINZ?*:

   WINZ Number:
Mobile Phone No:    Phone No:

Employer:

 Employers Phone No.

 

Debtor's current or previous address/es:

Debtor's previous addresses

Any other information that maybe of help collecting the debt

i.e debtors relatives contact details:
DEBTORS DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Address of Tenancy (where the debt occurred)*:

Date of Birth:

 Email:   

Are they on WINZ?*:

   WINZ Number:
Mobile Phone No:    Phone No:

Employer:

 Employers Phone No.

 

Debtor's current or previous address/es:

Debtor's previous addresses

Any other information that maybe of help collecting the debt

i.e debtors relatives contact details:

DEBT DETAILS

Do you have a debt collection clause?
Select "Yes" if you have a debt collection clause in your tenancy agreement.* 

Amount Owing*:                    

Date Incurred/Invoice Date: 

Court order number:             

Upload tenancy order:           

Upload other docs:                

Additional photo's, docs, orders etc email them directly to us by clicking here - please include your reference in the subject line.

Click here for pricing options

I have read and understood The CIA Debt Recovery Group Limited's terms and conditions*:

By accepting these terms, you agree to authorise The C.I.A. Debt Recovery Group Ltd to act as your agent 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.

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 The C.I.A. Debt Recovery Group Ltd. 

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

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