💼 Debt Relief Enquiry Form

Full Name* Email* Mobile Number* City* Marital Status* --Select-- Single Married Employment Status* --Select-- Not employed Working as salaried employed Self employed / Small business Business with more than 10 employees Monthly Income* --Select-- CURRENTLY NO INCOME LESS THAN RS.20000 PER MONTH RS.20000-RS.50000 PER MONTH RS.50000-RS.75000 PER MONTH RS.75000-RS.100000 PER MONTH RS.100000-RS.200000 PER MONTH ABOVE RS.200000 PER MONTH Credit Card Dues* --Select-- NO CREDIT CARD DUE BELOW RS.2 LAKHS RS.2 LAKH-RS.5 LAKH RS.3 LAKH-RS.4 LAKH RS.5 LAKH-RS.7.5 LAKH RS.7.5 LAKH-RS.10 LAKH ABOVE RS.10 LAKH Personal Loan Amount* --Select-- NO PERSONAL LOAN BELOW RS.2 LAKH RS.2 LAKH-RS.5 LAKH RS.5 LAKH-RS.7.5 LAKH RS.7.5 LAKH-RS.10 LAKH RS.10 LAKH-RS.15 LAKH RS.15 LAKH-RS.20 LAKH RS.20 LAKH-RS.50 LAKH ABOVE RS.50 LAKH Payment Status* --Select-- Paying full amount with difficulty Paying minimum due Not able to pay any Harassment Faced* --Select-- No harassment Many recovery calls Recovery calls and recovery agent visiting home/office Enrol in Debt Relief Programme?* --Select-- Yes No Willing to Pay ₹1500?* --Select-- Yes No Submit