Debt services certification application* Required fieldFirst name *Last name *Email address *Please enter a valid email address.Address *Display & Video 360 login emailIf different from aboveAdditional email addresses to copy on this requestAdd additional fieldPlease enter a valid email addressWebsite(s) *Add additional fieldDo you (or your client) offer debt services? *ex. Negotiating reduced, lump-sum payments that are regarded as payment in full; negotiating reduced periodic payments, reduced interest rates, and/or fees; debt settlement; debt management plans, individual voluntary arrangementsYesNoPlease select the country for which you are applying for certification *Select oneAustraliaBrazilCanadaGermanyJapanSouth AfricaSouth KoreaSpainUnited KingdomUnited StatesAre you or your client either a debt agreement administrator registered with the Australian Financial Security Authority or the holder of an Australian credit license? *Debt agreement administratorCredit licenseeNoWhat is your registration number?What is your license or registration number?Are you (or your client) a registered financial institution before Brazilian Central Bank? *YesNoWhat is your National Registry of Legal Entities (CNPJ) number?Are you (or your client) a Licensed Insolvency Trustee licensed by the Office of the Superintendent of Bankruptcy? *YesNoWhat is your full name on Licensed Insolvency Trustee License or firm name of Licensed Insolvency Trustees? *Select your or your client's qualification types below *Admitted Lawyer (Rechtsanwalt/Rechtsanwältin)Appointed Notary (Notar/Notarin)Appointed Tax Advisor (Steuerberater/Steuerberaterin)An appointed public accountant (Wirtschaftsprüfer/Wirtschaftsprüferin)Are you or your client an attorney or certified judicial scrivener? *AttorneyCertified judicial scrivenerNoWhat is the registration number of you or your client with the Japan Federation of Bar Associations? *What is the name of the judicial scrivener society of you or your client? *Are you or your client a debt counsellor registered with the National Credit Regulator? *YesNoWhat is your National Credit Regulator registration number? *Are you or your client a lawyer or law firm licensed to practice in South Korea? *YesNoAre you or your client a bankruptcy mediator registered by the Ministry of Justice? *YesNoIn what province is the bankruptcy mediator located? *Are you or your client authorized by the Financial Conduct Authority for financial services activities? *YesNoWhat is your reference number? *Are you or your client an approved non-profit budget and credit counseling agency, as defined by 11 U.S. Code § 111, or a national non-profit association representing non-profit credit counseling agencies? *YesNoPlease provide one state, U.S. territory, or commonwealth in which you or client is approved to provide credit counseling. *Select oneNational non-profit associationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingUpload a copy of all relevant licenses *Copy of licenses must be uploaded for this form, or application will not be accepted. Include any other documentation confirming permission to advertise these product or services in the country that you're applying for.Check if you agree with the statements belowI agree to inform Google as soon as the status of any information provided as part of this application changes, e.g. expiration, revocation, suspension, or narrowing of the scope or permissions of the license(s)/authorizations/registrations involved. *I confirm that the site(s) and ads included in this certification process comply with all applicable local legal requirements of the country and state(s) they will be targeted to. *SubmitSubmittedEdit requestDownload submission https://myaccount.google.com/privacypolicy?hl=$0 Some account and system information will be sent to Google, and support calls and chats may be recorded. We will use this information to improve support quality and training, to help address technical issues, and to improve our products and services, subject to our Privacy Policy and Terms of Service. Translation services may be used in chats and email. Additional info OK Your email has been sentThanks for contacting us. We'll follow up with you only if we need more information or have additional information to share.Edit requestDownload submission