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ADR-17-SECURED CREDITORS

THE INFORMATION PROVIDED IN THIS SECURED PORTAL IS STRICTLY USED ONLY FOR THE APPLICATION TO SUPPORT YOUR CLAIM FOR BANKRUPTCY.

This component of your application Statement of Financial Affairs the Government requires you to answer all question relevant to you, remembering this is a LEGAL document you are filing to the Government all answers must be accurately any false information can lead to court action against you and a possible jail term.
** ALL YES / NO QUESTION ARE TO BE ANSWERED.
** IF A QUESTION DOES NOT APPLY TO YOU GO TO THE NEXT QUESTION.
** ONCE COMPLETED FILL IN YOUR DETAILS AND SUBMIT TO US.

**NOTE THE YES/NO QUESTIONS WILL NEED TO BE TICKED, IF THE QUESTION IT IS NOT APPLICABLE TO YOU TICK “NO” AND MOVE TO THE NEXT QUESTION OTHERWISE AFTER SUBMIT THE FORM IT WILL REDIRECT YOU TO THE UNANSWERED YES/NO QUESTION TO COMPLETE.

List your secured creditors. (Creditors who are not secured should be listed UNSECURED portal) A secured creditor is a creditor who can repossess and sell your asset/s if you fall behind with your payments. For example, a mortgage over your house, a hire purchase/lease agreement over your vehicle, a chattel mortgage or a bill of sale over your business assets.

SECURED CREDITORS
A secured creditor is a creditor who can repossess and sell your asset/s if you fall behind with your payments.
For example, a mortgage over your house, a hire purchase/lease agreement over your vehicle, a chattel mortgage or a bill of sale over your business assets.
In this Form you will need to list all your secured creditors, this means loan given to you for the purchase of an asset.
DO NOT LIST UNSECURED CREDITORS HERE ON THIS PORTAL PAGE.
YOU MUST FILL THIS PAGE IN IF YOU HAVE A LOAN AGAINST AN ASSET EVEN IF YOU ARE UP TO DATE WITH PAYMENTS IT MUST BE DECLARED.
THE FORM HAS THE CAPACITY TO ALLOW FOR THREE(3) SECURED CREDITORS, ONCE COMPLETED SCROLL TO THE VERY BOTTOM TO SUBMIT.

SECURED CREDITOR NUMBER ONE(1)
SECURED CREDITOR NUMBER ONE-The Creditors name

SECURED CREDITOR NUMBER ONE- Creditors postal or street address

SECURED CREDITOR NUMBER ONE- Account Loan Number - (The Reference Number for this bill or Account number )

SECURED CREDITOR NUMBER ONE- Total amount owing to this creditor

SECURED CREDITOR NUMBER ONE- Type of security e.g. Mortgage

SECURED CREDITOR NUMBER ONE- Date the security was given

SECURED CREDITOR NUMBER ONE- Description of secured asset

SECURED CREDITOR NUMBER ONE- Physical Location of asset

SECURED CREDITOR NUMBER ONE- Estimated resale value of the asset

SECURED CREDITOR NUMBER ONE- Is this a joint loan
NoYes

SECURED CREDITOR NUMBER ONE- Are your repayments up to date
NoYes

SECURED CREDITOR NUMBER ONE- Has the creditor repossessed the asset
NoYes
SECURED CREDITOR NUMBER ONE- Are You Related creditor
NoYes

**IF YOU HAVE ONLY ONE SECURED CREDITOR SCROLL TO THE BOTTOM OF THIS PAGE AND FILL IN YOUR DETAILS AND SUBMIT
OTHERWISE CONTINUE BELOW

SECURED CREDITOR NUMBER TWO
SECURED CREDITOR NUMBER TWO- The Creditors name

SECURED CREDITOR NUMBER TWO- Creditors Postal or Street address

SECURED CREDITOR NUMBER TWO- Account Loan Number -(The Reference Number for this bill or account number )

SECURED CREDITOR NUMBER TWO- Total amount owing to this creditor

SECURED CREDITOR NUMBER TWO- Type of security e.g. Mortgage.

SECURED CREDITOR NUMBER TWO- Date the security was given-e.g. What Date did you take the loan out

SECURED CREDITOR NUMBER TWO-Description of secured asset

SECURED CREDITOR NUMBER TWO- Physical Location of asset

SECURED CREDITOR NUMBER TWO- Estimated resale value of the asset

SECURED CREDITOR NUMBER TWO- Is this a joint loan
NoYes

SECURED CREDITOR NUMBER TWO- Are repayments up to date
NoYes

SECURED CREDITOR NUMBER TWO- Has the creditor repossessed the asset
NoYes

SECURED CREDITOR NUMBER TWO- Are You Related creditor
NoYes

SECURED CREDITOR NUMBER THREE
SECURED CREDITOR NUMBER THREE- Creditors name

SECURED CREDITOR NUMBER THREE- Creditors Postal or Street address

SECURED CREDITOR NUMBER THREE- Account Loan Number -(The Reference Number for this Bill )

SECURED CREDITOR NUMBER THREE- Total amount owing to this creditor

SECURED CREDITOR NUMBER THREE- Type of security e.g. mortgage

SECURED CREDITOR NUMBER THREE- Date the security was given

SECURED CREDITOR NUMBER THREE- Description of secured asset-Home, Car, etc.

SECURED CREDITOR NUMBER THREE- Physical Location of asset

SECURED CREDITOR NUMBER THREE- Estimated resale value of the asset

SECURED CREDITOR NUMBER THREE- Is this a joint loan
NoYes
SECURED CREDITOR NUMBER THREE-Are repayments up to date
NoYes
SECURED CREDITOR NUMBER THREE-Has the creditor repossessed the asset
NoYes

SECURED CREDITOR NUMBER THREE- Are You Related creditor
NoYes

EQUITY LOANS LOAN WITHDRAWALS AGAINST SECURED PROPERTY
Have you used any equity or made any additional loan withdrawals against any of the above secured property in the last 12 months
NoYes
Date Withdrawn Equity

Amount Equity Withdrawn $

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ADR-17-SECURED CREDITORS

ADR-17-SECURED CREDITORS

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