Upload General Debt
You can download this form here and email it to firstname.lastname@example.org if you have trouble with this online form.
Your Bank Account Number (for direct credits)*: - - -
Date of Birth:
Are they on WINZ?*:
Other address/es you have for the debtor:
Any other information that may be of help collecting the debt
i.e debtor's relatives contact details:
Upload photo of debtor:
Any other information that maybe of help collecting the debt
i.e debtors relatives contact details:
Add another debtor
Do you have a debt collection clause?
Select "Yes" if you have a debt collection clause in your contract.*
Date Incurred/Invoice Date*:
Court order number:
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
Please click here to choose your pricing optionOption 1 - No active Debt Collection – Debt will be lodged Tenancy Information NZ. Registration Fee $30 + GST.Option 2 - Any Debt Size. Registration Fee $160 + GST. C.I.A commission rate of 25% commissionOption 3 - $3,000 Minimum Debt Size. Registration Fee $80 + GST. C.I.A commission rate of 30% commissionOption 4 - Any Debt Size. Registration Fee $80 + GST. C.I.A commission rate of 40% commissionOption 5 - $1,000 Minimum Debt Size. No Registration Fee. C.I.A commission rate of 50% commission
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.
PO BOX: 106-472Auckland City 1143
0800 111 007
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