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

Company:

Full Name*:

 Contact Person:

Email*:

Phone No*:

Address*:

Bank Account Number (for debtor repayments)*: - -  -  

Your Reference:

illion Tenancy member ID: illion Tenancy
DEBTOR DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Tenancy Address (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

Other information that may be of help collecting the debt

i.e debtor's relatives contact details:

Upload photo of debtor:

    
DEBTOR DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Tenancy Address (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

Other information that maybe of help collecting the debt

i.e debtors relatives contact details:
DEBTOR DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Tenancy Address (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

Other information that maybe of help collecting the debt

i.e debtors relatives contact details:
DEBTOR DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Tenancy Address (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

Other information that maybe of help collecting the debt

i.e debtors relatives contact details:
DEBTOR DETAILS

First Name*:

Surname*:

Middle Name:

 Gender*:  

Tenancy Address (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

Other information that maybe of help collecting the debt

i.e debtors relatives contact details:

DEBT DETAILS

Amount Owing $*:                                              

Court Order Number:            

Date Incurred/Invoice Date:  

Does your tenancy agreement have a debt collection clause *: 

Upload tenancy 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 for 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.

How did you hear about us?