CBC International
CBC International

Debt Claim Instruction Form

Your Details  
Client Name*
Client Address
Postcode
Telephone Number
Fax Number
Email*
Authorised Individuals Name
Authorised individuals Position in company
Litigation Case Details  
Defendant’s Name
Defendant’s Address
Postcode
Amount of Claim Inc Court Fee
Statement of Authorisation

I hereby authorise Debt Claim Legal Services to commence legal proceedings on our behalf against the organisation/individual detailed above. I confirm that Debt Claim Legal Services are merely acting in a consultancy capacity in this matter. I confirm that Debt Claim Legal Services will not be held responsible for any acts, omissions or losses whatsoever as a result of the consultancy they provide. I also confirm that this adheres to Practice direction which supplements CPR Part 22 in particular 3.1 (2). I also confirm that Debt Claim Legal Services are hereby authorised to contact the court on my behalf in order to discuss any detail of my case.
Authorisation of costs
I hereby confirm that Debt Claim Legal Services have estimated the maximum fee (excluding court fees, disbursements) to be charged on the account as 5 hours work. I have been quoted an hourly rate of £50 per hour. I confirm that I have been provided with information in relation to potential further court fees. I hereby confirm that I am authorised to accept these fees on behalf of my company/Organisation. I also confirm that should a period of more than 5 hours be required to complete this case then Debt Claim Legal Services must obtain a supplemental authorisation from me in order to have these additional costs authorised. Upon successful collection of any monies or security of funds, the commission rate agreed under our debt recovery service will also apply.
Date
Particulars of Claim
The Claimant supplied goods/services to the defendant to the value of £
The claimant rendered invoices as follows payable within days from date of invoice.
Inv No Date Amount
Despite requests to the defendant, the invoices remain outstanding for payment.  
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