Subject: Recording of payment information and removal of a payment default
entry

I request that the payment of the following claim be recorded in the credit
information register and that the entry be removed in accordance with the
Credit Information Act:

Creditor: [NAME]
Claim/reference: [NUMBER]
Paid in full: [DATE]

A certificate of payment is attached.

[DATE]
[FIRST NAME LAST NAME, PERSONAL IDENTITY CODE, ADDRESS]