Name: Collect My Debt Ltd
Address: 85 Great Portland Street, First Floor, London, W1W 7LT
Telephone: 0800-612-5161

Residential Debt Recovery Instruction Form

Defaulter Details*
Forename Surname D.O.B. Email: Tel No:
Address:*
Street Address Address Line 2 City County Postal Code Country
If you cannot confirm the current details for the person in question, the likelihood of success is significantly reduced. Please also complete a Trace Instruction form.
Amount Overdue:*
Number of months rent is outstanding:*
Monthly Rent:*
Dilapidations*

Please attach all information regarding dilapidation i.e. pictures, list of dilapidation, quotes etc.
Deposit Held:*
Has the deposit been used to reduce the amount of debt?*
Please attach supportive information such as Invoice, Statement of Arrears, Agreements etc.
Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 16 MB.
Additional Defaulter Information
Instructing Client Details
Company name:
Your Name:*
First Last
Your contact details:
Tel No: Mobile No: Email Address:
Your Address:*
Street Address Address Line 2 City County Postal Code Country
Remittance Details:*
Bank Name: Bank Address: Account No: Sort Code Reference:
Notes: Percentage commission of debt monies recovered (15% plus VAT for tenants still in situ) (25% plus VAT for tenant/s who have absconded or been evicted from the property or been served a section 21 or section 8 notice).
CAPTCHA
It is a condition of this instruction that all directors, shareholders and members of the Claimant Company (where applicable) personally guarantee Collect My Debt Limited's fees, costs and charges. Review our Terms & Conditions*
- I agree to the Terms and Conditions
It is a condition of this instruction that all directors, shareholders and members of the Claimant Company (where applicable) personally guarantee Collect My Debt Limited's fees, costs and charges.

Review our Terms & Conditions
Signature:*
Please sign below to Instruct us and accept our Terms & Conditions - you can sign this using either a mobile / tablet touch screen or PC Mouse / laptop mouse pad
Date of Instruction
DD slash MM slash YYYY

Residential Debt Recovery Instruction Form

If you cannot confirm the current details for the person in question, the likelihood of success is significantly reduced. Please also complete a Trace Instruction form.

Instructing Client Details

Notes: Percentage commission of debt monies recovered (15% plus VAT for tenants still in situ) (25% plus VAT for tenant/s who have absconded or been evicted from the property or been served a section 21 or section 8 notice).

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