I/we hereby authorise Fix Bad Credit to act on my behalf in relation to the following matters

  • To obtain a copy of my credit report, and credit file held by creditors.
  • To view any and all information held by any Credit Reporting Agency, any Credit Provider, and any Government Department.
  • To enter into negotiations with any party in regard to credit agreement/debt owed.
  • To enter into negotiations with any party as may be required in order to achieve a deletion, amendment, or correction to my/our credit file.

This authority is given in accordance with the Privacy Act 1988.
This authority continues to be in force until such time as the retainer between myself and Fix Bad Credit has been satisfied or until such time as my authority is revoked in writing.

    TITLE: FIRST NAME: MIDDLE NAME:
    SURNAME: DATE OF BIRTH:

    Current Address:

    STREET NUMBER: STREET NAME: TOWN/CITY:
    STATE: POSTCODE:
    PERIOD OF TIME AT ADDRESS:

    Previous Address

    (Fill out if time at Current Address is less than 2 years)
    STREET NUMBER: STREET NAME: TOWN/CITY:
    STATE: POSTCODE:
    MEDICARE CARD COLOUR: MEDICARE #: REF #:
    MEDICARE EXPIRY:
    DRIVERS LICENCE #: STATE: DRIVERS LICENCE EXPIRY:
    SIGNATURE: [signature* signature-parent id:test] DATE:

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