Help with debts | W4AwBank New York

Do you want help with debt resolution? That's what we're here for! You can request debt assistance using the form below.

After receiving the application, W4AwBank New York will look for a suitable solution for you. One of our employees will contact you.

TIP: if you immediately add your ID, your application will be processed faster.

By submitting this application form, you give W4AwBank New York permission to include your personal data in the personal register of W4AwBank New York and to process it in the context of debt counseling.

First enter your zip code to check whether we provide debt assistance in your municipality:

Postcode *

Surname *

Initials *

First names *

Birthdate *

Birthplace *

Citizen Service Number *

House number *

House number addition

Street *

City *

Your municipality *

Email address *

Phone number *

Bank account number *

Bank name *

Number and ages of children living at home *

Your job

Net income

Health insurance premium per month ($)

Other income (e.g. child-related budget, received alimony, etc.)

Other fixed expenses with explanatory notes (e.g. alimony)

Space for explanation

Documentary evidence Fixed charges: Add file (s)

Allowed file types: jpg, jpeg, gif, png, bmp, doc, docx, xls, xlsx, pdf

Evidence Other: Add file (s)

Allowed file types: jpg, jpeg, gif, png, bmp, doc, docx, xls, xlsx, pdf

NOTE: If you add your ID immediately, this will speed up the processing speed of your application.

I agree with the processing of personal data in the context of your (debt) assistance request. *

Agree with the processing of personal data in the context of your (debt) assistance request (partner). *