Tenancy icon 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   illion Tenancy    (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.

How did you hear about us?