A guide to filling in Form 4a
Notification to the money adviser on consent of the creditor
You can use form 4a to inform the placing a X against one, and only
money adviser of whether you one, of the options in parts17 & 18. If
consent, do not consent to the debt you do not place a X in any of the
payment plan proposed in form 4. boxes, it will mean that you will be
deemed to have consented.
If you are filling in a paper copy of the
form you must write clearly in block If you consent to the DPP proposed in
capitals using black ink. You must not form 4 you should place a X in the
write outside the boxes. You must appropriate box 17.
give all dates in the format
dd/mm/yyyy. Or, if you do not consent to the DPP
proposed in form 4 you should place a
Before you fill in and send the form, we X in the box 18, and give the reasons
recommend that you read the relevant why in the space provided.
parts of the DAS creditor’s guidance.
You should keep a signed and dated
paper version of this form. To ensure that any funds disbursed go
to the correct account (if this DPP is
Part 14: Name of creditor approved), please give the following
If not already complete, give the name
of your company or firm, or if the account holder’s name as it
appropriate, your full name. appears on
the appropriate account;
Part 15: Name of debtor the account number; and
the account sort code.
If not already completed, give the
name of the debtor. You can find this You should provide these details
on form 4. whether you have consented or not, to
the DPP proposed in form 4.
Part 16: Money adviser’s reference
number Part 20
If not already complete, give the In part 20 you should:
money adviser’s reference number.
You can find this on form 4. sign the application;
print your name;
Parts 17 & 18 give the name of your company
Indicate your response to the request date the application
for consent to the proposed DPP by