About this Guide

If you wish to apply for relief from debt you will need to provide us with details of your income and expenses. This form enables you to provide us with those details so that we can assess your situation when applying for relief from debt.

This form can be completed on-screen by typing content directly into the PDF document. Once you have completed the form it is important that you print it out as you will not be able to save the information you enter into the form.

When to use this guide

This form is to be completed by individuals in business or non-individuals and attached as supporting information when you are making an application for relief from payment of a debt. It is important that you send this form in as soon as you can. We can only consider and/or accept an arrangement when we receive written application from you.

What you will need

On sucessfully complete and submit this form you will need:

• Your IRD number – if you do not have this call us on 0800 227 774.
• Details of your income after tax.
• Details of your weeky and monthly expenses.
• Details of any assets or liabilities.

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