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Refer a debt

Refer a debt

This form gives us what we need to verify the account and act on it.

Fields marked with * are required. If something doesn't apply, write "N/A" rather than leaving it blank.

Before you start: have your contract or terms, the invoices, the payment history and the date of the last payment ready. We can't start collection without evidence of the debt and of your authority to instruct us.

1 Your business

11 digits

2 Who owes the money

if the debtor is a business
only if you lawfully hold it

3 The debt

for example: clause 8 of our trading terms, 10% a year. Interest and costs can only be claimed where a contract term or a statute permits it.
Type of debt*

4 Status of the account

Answer each one — if you don't know, choose Unknown rather than guessing.

{{YNU|s4_disputed|Has the debtor disputed the debt, in whole or in part?}} {{YNU|s4_faulty_goods|Has the debtor claimed the goods or services were faulty or not supplied?}} {{YNU|s4_hardship|Has the debtor told you they're in financial hardship, unwell or vulnerable?}} {{YNU|s4_deceased_bankrupt|Is the debtor deceased, bankrupt or in external administration?}} {{YNU|s4_legally_represented|Is the debtor legally represented?}} {{YNU|s4_acknowledged_or_part_paid|Has the debtor acknowledged the debt in writing, or part-paid it, since it fell due?}} {{YNU|s4_court_proceedings|Have court proceedings been started, or judgment obtained?}} {{YNU|s4_referred_before|Has the debt been referred to another agency before?}}

5 What you're authorising us to do

Basis of our authority*
What we may do
for example: 12 monthly instalments
{{YNU|s5_approval_required|Must you approve any settlement before we accept it?}}

6 Documents you're sending

Tick everything you're attaching.

Documents
Click to choose files or drag them here
PDF, JPG, PNG, DOC or XLS. Up to 5 files, 15MB each. Files are stored privately and only accessible to Blac Blok staff.

7 Your declaration

By submitting this referral you confirm that:

  • the debt is genuinely owed and, so far as you know, legally enforceable
  • the balance is accurate at the date of referral, apart from anything disclosed above
  • the documents you've supplied are true copies of your records
  • you're entitled to collect this debt and authorised to instruct us
  • you've disclosed every dispute, payment, hardship request and court proceeding you know of
  • you'll tell us promptly if the debtor pays you directly, disputes the debt, or anything else material changes
  • you're authorised to give us the personal information in this form for the purpose of collecting the debt
✓

Referral sent

We'll confirm receipt within one business day and tell you if anything's missing.

Ref:
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