A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator. Email Are you private or business: Private Business __________________________ Details claim Are you already a customer of Collection Company? Yes No Do you have money owed by a private individual or a company / organization Private Business Do you have a claim within the Netherlands, within Europe (outside the Netherlands) or outside Europe? In the Netherlands Within Europe (outside the Netherlands) Outside of Europe Do you have one claim or multiple claims? I have one claim I have several advances ---- Deposit (house/building) Rent arrears (house/building) Rental commission ruling Loan Wage Enforce judgment Lease & rental (no house/building) Damage and compensation Contracting work (construction / maintenance / repair) Delivered, not paid Paid, not delivered Overpaid amount Money transferred to wrong account Otherwise describe below ---- Euro (Euro countries) Peso (Argentina) Dollar (Australia) Real (Brazil) Dollar (Canada) Franc (Swiss) Yuan (China) Koruna (Czech Republic) Crown (Denmark) Crown (Estonia) Pound (United Kingdom) Dollar (Hongkong) Kuna (Croatia) Forint (Hungary) Rupiah (Indonesia) Shekel (Israel) Rupee (India) Yen (Japan) Peso (Mexico) Ringgit (Malaysia) Crown (Norway) Dollar (New Zealand) Peso (Philippines) Zloty (Poland) Ruble (Russia) Crown (Sweden) Dollar (Singapore) Baht (Thailand) Lira (Turkey) Dollar (USA) Rand (South Africa) Amount For a quick handling of your case, it is important that you fill in the form as completely as possible. When did your tenancy agreement end? Have agreements been made about the repayment of the loan? yes no Upload your loan agreement and/or other evidence or specify below Loan specification Upload the decision of the rent assessment committee here For which months do you still need to receive an amount back and which months does it concern? Upload your specification here or specify it below Upload your rental agreement here Specification of amount to be refunded comment Relevant documents (contract, assignment, correspondence, general terms and conditions). You can upload multiple files Each file you upload can have a maximum size of 2 MB. Do you want to upload more files? yes no Are your files too large? Please send them manually by email via WeTransfer to info@collection-company.com. Which rental months are currently still open and what is the amount per month? Upload your specification here or specify it in the text box below. Rent arrears specification Send
