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Debt Declartion Form
 
 
First Name
Mobile # *
Office #
Email ID
Employment status
Monthly income
Other source of income
Responsibilities
   
   
Last Name
Land Line #
Other Contact #
Language
Name of last company worked
Number of dependents
Monthly repayment capacity *
   
   
   
Product 1
Type of Debt
Name of debtor

Repayments

Any Current settlement Plan
Credit Amount
Setup date
Current Outstanding
Remarks
Product 2
Type of Debt
Name of debtor

Repayments

Any Current settlement Plan
Credit Amount
Setup date
Current Outstanding
Remarks
Product 3
Type of Debt
Name of debtor

Repayments

Any Current settlement Plan
Credit Amount
Setup date
Current Outstanding
Remarks
Product 4
Type of Debt
Name of debtor

Repayments

Any Current settlement Plan
Credit Amount
Setup date
Current Outstanding
Remarks
 
I here by declare and verify all of the above mentioned information provided and authorize Mahandru Assosiates to customize a debt relief plan for me.
 
 
 
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