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Debt Collection Tool
Online Debt Collection
25
%
Page 1: Welcome ! Let's begin Debt Collection Process with your details:
CLAIMANT’S DETAILS
*
INDIVIDUAL
COMPANY
Please provide us some more information about you:
Your name
*
Please select
Mr
Mrs
Ms
Miss
Dr
Prefix
First
Last
Phone
*
Email address
*
Country of residence:
*
Postcode:
*
Physical Address:
*
Please provide us with some more information about company:
Name of company
*
Country of incorporation:
*
Company’s registration number:
*
Address of registered office:
*
Are you VAT registered?
*
Yes
No
Please enter VAT number:
Please provide us contact person details in company:
Contact Person Name
*
Please select
Mr
Mrs
Ms
Miss
Dr
Position in Company:
*
Phone :
*
Email address
*
Country of residence
*
Postcode
Physical Address:
*
Continue to Debtor’s Details
PAGE 2: Perfect, Now Select an option & let's fill debtor's details
DEBTOR’S DETAILS :
*
INDIVIDUAL
COMPANY
Name
*
Please select
Mr
Mrs
Ms
Miss
Dr
Prefix
I.D./ Passport number:
*
Country of issuance of I.D./ Passport:
*
Do you know if the debtor is bankrupted?
*
Yes
No
Please provide more info:
Please provide us some more information about debtor:
Nationality:
*
Telephone number:
*
Email address
*
Country of residence:
*
Mobile Number
*
Physical Address of debtor
*
Postcode:
Please provide us some more information about company:
Name of company:
*
Company’s registration number:
Country of incorporation:
*
Address of registered office:
*
Please provide contact person details:
Full Name
*
Please select
Mr
Mrs
Ms
Miss
Dr
Prefix
Position in Company:
Telephone number:
*
Mobile number:
Email address
*
Country of residence:
Postcode:
Physical Address:
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Continue to next page
Page 3: Please fill in Debt Type & Total Amount of claim:
Currency
*
Please select
$
€
£
¥
₽
CHF
Total amount of claim:
*
Since When amount is due?
Debt type:
*
Invoices
Written agreement
Verbal Agreement
Please provide below detailed invoice related information:
Invoice details
*
Add / Upload Invoice
Please note that the uploaded document should be in English language or translated in English which shall be accompanied with the original document. In case you wish the translation be done with us please upload the document and you will receive our quotation and if you agree you can continue with the application.)
Were invoices delivered to recipient?
*
yes
no
Invoices properly stamped and signed by issuer?
*
yes
no
Invoices signed by recipient?
*
yes
no
Please provide below detailed agreement details:
Date of Agreement
*
Place where the Agreement was signed:
*
Governing jurisdiction (Country)
*
Substantial terms of the Agreement:
Add / Upload
Please note that the uploaded document should be in English language or translated in English which shall be accompanied with the original document. In case you wish the translation be done with us please upload the document and you will receive our quotation and if you agree you can continue with the application.)
Please provide below detailed verbal agreement details:
Date of Agreement
*
Governing jurisdiction (Country)
*
Substantial terms of the Agreement:
Description of goods or services provided:
Description of terms of payment:
Did the debtor make any payments?
*
yes
no
Date
Amount
Are there any guaranties in place?
*
yes
no
Last date of contact/communication with debtor:
Were any attempts made or any steps taken to collect the amount due?
*
yes
no
In which way?
Current status of this debt:
*
Late Payment
Court Order
Did you take any legal actions against the debtor?
*
yes
no
If Yes: Please give more info
Do you have any court order against the debtor?
*
yes
no
Name of the court
(If Yes) Date of Judgment:
Case number:
Amount owned based on the Court order:
Are there any pending procedures/actions based/ or against the court order?
*
yes
no
(if Yes) Please give more info:
*
Upload any relevant documents for the above actions
Please note that the uploaded document should be in English language or translated in English which shall be accompanied with the original document. In case you wish the translation be done with us please upload the document and you will receive our quotation and if you agree you can continue with the application.
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Continue to next page
Last Page: Please mention any other details related to Business Activities of Debtors:
Business Activities
*
Individual
Company
Debtor’s business activities:
Does the debtor have assets ?
Yes
No
Assets are ?
Movable
Immovable
Movable assets are
immovable assets are
Approximate turnover:
Number of Employees:
Have you ever cooperated in the past with the debtor ?
Yes
No
(If Yes): Provide details:
Was he consistent in his previous transactions?
Yes
No
Have you met him in person?
Yes
No
Debtor other business:
Other Companies to which Debtor or person related to Debtor is associate with/ linked to :
Please provide name and relationship:
Has the Debtor sold any assets within the period after the debt was incurred?
Yes
No
(If Yes) Please give more information: (to whom, if relative, details of property)
Please provide details
Are you aware of any third party owing any debt to this debtor?
Yes
No
unknown
(If Yes) Please give more information:
Please provide details
Please provide us with any other information you may deem relevant:
Debtor’s business activities:
Where are the company’s statutory books held?
Is the Company in good standing?
Yes
No
unknown
When did the company ceased to be in good standing?
Does the debtor have assets
Yes
No
Assets are ?
Movable
Immovable
Movable assets are
immovable assets are
Approximate turnover:
Number of Employees:
Do you know if debtor owns or lease its premises
Yes
No
Have you ever cooperated in the past with the debtor?
Yes
No
(If Yes): Provide details:
Was he consistent in his previous transactions?
Yes
No
Have you met in person any of the Directors/representatives/contact persons of the Company?
Yes
No
Name
Position
Contact
Debtor’s other business:
Other Companies to which Debtor or person related to Debtor is associated with/ linked to:
Has the Debtor sold any assets within the period after the debt was incurred?
Yes
No
Unknownn
Please give more information: (to whom, if relative, details of property:
Do you know if there are any associated or subsidiary Companies
Yes
No
Please give more information: (to whom, if relative, details of property:
Are you aware of any party owing any debt to this debtor?
Yes
No
Please give more information: (to whom, if relative, details of property:
Please provide us with any other information you may deem relevant:
Upload
(Please note that the uploaded document should be in English language or translated in English which shall be accompanied with the original document. In case you wish the translation be done with us please upload the document and you will receive our quotation and if you agree you can continue with the application.)
Please type the characters
*
This helps us prevent spam, thank you.
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Submit your claim
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