Process data File number Debtor data Salutation Please select!MrMrs First name Last name Company name Street, No. Postcode City Phone E-Mail Telefax Date of birth Your request Ihr Anliegen You wish to reconcile payment conditions with us You allready payed the claim amount You cannot currently pay You like us to call you back free of charge You like to submit your new adress You have objections to the claim I have no objection to the claim under the specified procedure, and acknowledge the claim. I would like to pay the claim amount as follows: Forderung zahlen Zahlung Auswahl Auswahl Complete payment /one-time payment Proposed instalment payment Instalments will be transferred to the account specified in the collection-letter. I hereby authorise ADF to collect the specified instalment payments from my account. Gesamtzahlung Total amount of € plus further interest(a deferment cannot be granted for longer than three months.) Payment will be made not later than Ratenzahlung Monthly instalments of € Payment dates First payment on Abbuchung My account details are: Account No. Bank Sort code Account holder You allready payed the claim amount Payment date Amount Proof of payment Payment receipt / transfer enclosed as attachment (see end of form) Copy of payment receipt / transfer will be sent separately Evidence Hochladen Nur eine Datei möglich.200 MB Limit.Erlaubte Dateitypen: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. The claim amount cannot be paid because of Keine Zahlung Grund Keine Zahlung Grund Auswahl Unemployment (please attach the corresponding decision) Affidavit submitted on Out-of-court debt settlement Institution of insolvency proceedings Other Abgabe der Eidestattlichen Versicherung Affidavit date File reference Court Out-of-court debt settlement Debt settlement plan of Debt consultant Insolvenzverfahren Application date Institution date File reference Court Administrator Sonstiges SonstigesGrund Arbeitslosigkeit Nachweise beifügen Hochladen Nur eine Datei möglich.200 MB Limit.Erlaubte Dateitypen: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Statusmeldung × You would you like us to call you back free-of-charge? No problem. Simply give us your telephone number, and let us know when we can reach you best. Please note that we can only call you back during our normal office hours. We are available at the following times: Mo-Fr: 8:00am - 6:00pm Call-back for freeYou would you like us to call you back free-of-charge? No problem. Simply give us your telephone number, and let us know when we can reach you best. Please note that we can only call you back during our normal office hours. We are available at the following times: Mo-Fr: 8:00am - 6:00pmWhen do you wish us to call? Date Time Please select!at all hoursin the morningat noonin the afternoonin the evening Phone Your adress is incorrect or has changed.Please use this form to submit your actual address. Street. No. Postcode City The following objections are made to the claim Einwände I agree I agree I agree that my contact information and allocation will be stored permanently for any possible queries. Note: You can revoke this consent at any time with effect for the future by sending an e-mail to info@adf-inkasso.de Submit