Your Company Information Please put your Company Details Company Name / Individual Example: +971 00000000 Please provide contact person's Name Please provide your Company's working email address Example: +971 00000000 Please provide Accounts or Finance Team Email Defaulter / Debtor Details Company / Individual Example: +971 00000000 Key Contact Person's Name Please provide working email address Example: +971 0000000 Please provide working email address Claim Amount* Enter the Amount in Digits Status* Defaulter is contactableDefaulter not contactable Defaulter's Country* Please mention the Country where Company is located Please write your dispute in brief Currency* AEDUSDEURQARSARKWDINRPKRGBP Documents Available Statement of Account (Current Dated)Invoices / LPO / Delivery Order / Delivery Note CopiesOriginal Bounce Cheque and Bank Return Slips (If any)Signed Contracts (If any)Email Correspondences (If any)Bill of Lading / Packing List / Packaging List (if any) Please Tick those documents which are available in this Case Have you filed any Criminal Case* YesNoN/A Have you Filed any Civil Case* YesNoN/A N/A (not applicable for this case)Original Cheques (bounced Cheques, Security Cheques EtcCheque Copies Only Kindly select the appropriate option from the drop down list Total Number of Cheques 01234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950 Please mention how many cheques are available Provide Undertaking Please Tick Both Options* I, hereby, confirm that the above details are correct to the best of my knowledge and the case is given to Mena Associates and Partners L.L.C-FZ.Any Settlement done by the Debtor from this date onwards, We are liable to pay Commission to Mena Associates and Partners L.L.C-FZ as per the Agreement.
