Debt services certification application

First name *

Last name *

Email address *

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Address *

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Website(s) *Add additional field

Do you (or your client) offer debt services? *

ex. Negotiating reduced, lump-sum payments that are regarded as payment in full; negotiating reduced periodic payments, reduced interest rates, and/or fees; debt settlement; debt management plans, individual voluntary arrangements

Please select the country for which you are applying for certification *

Are you or your client either a debt agreement administrator registered with the Australian Financial Security Authority or the holder of an Australian credit license? *

What is your registration number?

What is your license or registration number?

Are you (or your client) a registered financial institution before Brazilian Central Bank? *

What is your National Registry of Legal Entities (CNPJ) number?

Are you (or your client) a Licensed Insolvency Trustee licensed by the Office of the Superintendent of Bankruptcy? *

What is your full name on Licensed Insolvency Trustee License or firm name of Licensed Insolvency Trustees? *

Select your or your client's qualification types below *

Are you or your client an attorney or certified judicial scrivener? *

What is the registration number of you or your client with the Japan Federation of Bar Associations? *

What is the name of the judicial scrivener society of you or your client? *

Are you or your client a debt counsellor registered with the National Credit Regulator? *

What is your National Credit Regulator registration number? *

Are you or your client a lawyer or law firm licensed to practice in South Korea? *

Are you or your client a bankruptcy mediator registered by the Ministry of Justice? *

In what province is the bankruptcy mediator located? *

Are you or your client authorized by the Financial Conduct Authority for financial services activities? *

What is your reference number? *

Are you or your client an approved non-profit budget and credit counseling agency, as defined by 11 U.S. Code § 111, or a national non-profit association representing non-profit credit counseling agencies? *

Please provide one state, U.S. territory, or commonwealth in which you or client is approved to provide credit counseling. *

Upload a copy of all relevant licenses *

Copy of licenses must be uploaded for this form, or application will not be accepted. Include any other documentation confirming permission to advertise these product or services in the country that you're applying for.

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