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Working hours today: until 17:00
phone number: 033 - 47 00 000
More contact details and hours of business
Selecteer uw vestiging:AmersfoortBeverwijk

Requesting a payment plan

We request the information below because we need it to consider and process your request for a payment plan. The information you provide will remain secure and will only be used for the aforementioned purpose. We will handle your data with care. 

For whom do you apply for the plan?




Initials*

Infix

Last name*

Street

House number

Postal code

Town/City

Date of birth*

Please note: If you complete this form for your partner, make sure to enter his or her date of birth. If this date of birth does not correspond to the date of birth in our system, we will be unable to process your application.

Email address*

Telephone number*

Next

Debt assistance/administration name*

CoC number debt assistance/administration*

Your initials*

Your infix

Your last name*

Your email address*

Telephone no.*

Authorisation form or decision by debt assistance for your client*

Next

Initials client*

Infix client

Last name client*

Date of birth client*

Please note: If the date of birth of your client does not correspond to the date of birth in our system, we will be unable to process your application.
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Company name*

CoC number company*

Initials contact*

Infix contact

Last name contact*

Email address contact*

Contact telephone no.*

Next
Back to form

Where can I find the case number?

Your case number contains 7 or 8 characters
and can be found at the top of all our letters.

Case number*

Momenteel is er een technische storing en werkt het contact formulier niet naar behoren. U kunt alsnog contact zoeken via telefoonnummer 033 – 47 00 000 of start een chat rechtsonder op deze pagina.The entered file number cannot be found, please check the entered file number.
If you are certain that you have entered the correct file number, please contact 033 - 47 00 000 or start a chat at the bottom right of this page so that we can assist you further.Het ingegeven dossiernummer is gesloten en er kan dan ook geen betaling voor gedaan worden.

Instalment amount

Term duration

How many payment instalments do you want to use?How many payment instalments can your client use?*

If you wish to apply for a payment plan of 7 instalments or more, we will ask you for more information about your income and expenditure. We need this information to be able to assess your proposal.

Effective date of the plan*

BackNext

What is your household situation?*

Children*

Monthly income*

Monthly expenditure*

Other debts*

Upload substantiating documents

Possible explanation

BackNext
You can pay the first instalment now. By paying the first instalment immediately, you will have repaid your debt sooner.

Do you want to pay the first instalment?

I declare that I have filled in everything truthfully

I give permission to share the information I have provided with the creditor

BackSend
Back to form

Where can I find the case number?

Your case number contains 7 or 8 characters
and can be found at the top of all our letters.

Payment using iDEAL

Enter your details here

* Required field

Your email address*

Thank you for applying for a plan. We will assess your application and respond within 2 workdays. We may require additional information before we can conclude a plan. We will send an overview of the application to the provided email address.
Please note: Not all mandatory fields have been completed.