Client Authority, Consent and Service Agreement

Complete this online form before Clearfile communicates with third parties or starts debt correspondence administration.

Online authority form

This form is submitted securely through the form provider and sent to Clearfile Correspondence in a structured email. You should receive an automated confirmation email after submission.

One of the text fields is over its word limit. Please shorten it before submitting.

1. Client details

Full name

Email address

Telephone number

Date of birth, optional

Postal address

2. Service requested

Service type

Number of active debts/accounts

For monthly debt administration, this should match the Stripe quantity.

3. Matters / active debts covered

List each creditor, collector, organisation, account/reference number or matter covered by this authority. If there are more than six, add the remainder in the notes box below.

Creditor / organisation 1

Reference/account

Status

Notes

Creditor / organisation 2

Reference/account

Status

Notes

Creditor / organisation 3

Reference/account

Status

Notes

Creditor / organisation 4

Reference/account

Status

Notes

Creditor / organisation 5

Reference/account

Status

Notes

Creditor / organisation 6

Reference/account

Status

Notes

Additional matters or notes

0 / 1,000 wordsMaximum 1,000 words

4. Authority and consent

5. Typed signature

Typed signature

Date

By typing your name and submitting this form, you confirm that the information supplied is accurate to the best of your knowledge and that you agree to the authority, consent and service acknowledgements above.

Back to authority page

Before submitting

Do not include bank card numbers, passwords, security answers or unnecessary sensitive information. If supporting documents are needed, Clearfile will request the relevant information separately.

Response time

After submission, Clearfile aims to review the form within 48 hours.

Important limitation

This form gives administrative correspondence authority only. It does not create a solicitor-client relationship and it does not make Clearfile responsible for the underlying debt, account, complaint, court deadline or financial decision.

Payment

If you are paying for monthly debt correspondence administration, the Stripe quantity should match the number of active debts or creditor accounts.

View payments