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FULL ONLINE BANKRUPTCY

PRESCRIBED INFORMATION IMPORTANT: You must read this information before you sign the Bankruptcy Form.
This page contains essential information about the consequences of, and alternatives to, bankruptcy.
Your assets may be sold.
You will be able to keep ordinary household goods, some tools you use to earn an income (up to a certain value)*, and some vehicles if you use them primarily as a means of transport (up to a certain value)*, but other assets (including your house) can be sold by your trustee.
If you acquire, receive or inherit any assets while you are bankrupt you must tell your trustee.
You cannot conceal, remove or dispose of any assets inside or outside Australia.
If you do, you may be subject to criminal prosecution.
Your income, employment and business may be affected.
If your income exceeds a limit*, you may be required to make contributions from your income to your trustee.
You cannot be a director of or manage a company.
Some professional/licensing bodies may restrict or prevent you from continuing in that trade or profession. You may not be able to hold certain public positions such as a member of parliament.
If you are in business and trade under a business name different to your personal name, you must tell everyone you deal with that you are bankrupt.
If you don’t, you may be subject to criminal prosecution.
Your ability to travel will be affected.
You will not be able to travel overseas without written permission from your trustee.Your ability to obtain credit and certain services may be affected.

You may find it hard to borrow money or buy things on credit.
You may find it hard to obtain approval to rent properties and get electricity, gas, water and phone connections without paying bonds. Some banks may not let you operate certain accounts or restrict how you operate accounts.
If you obtain loans or buy goods and services on credit (including under hire purchase, leasing or instalment arrangements) over a certain value* you must tell the provider that you are bankrupt.
If you receive payments for supplying goods or services totalling more than a certain value* you must also tell the purchaser that you are bankrupt.
If you don’t disclose your bankruptcy in these circumstances, you may be subject to criminal prosecution. You may not be released from all your debts.
Not all debts are covered by bankruptcy.
You must continue to pay debts, such as penalties, fines, child support and debts incurred by fraud.
If you have an asset which is under finance or a mortgage (car, house, etc) and you do not maintain your repayments, the creditor can repossess and sell the asset; however the shortfall, if any, will be covered by bankruptcy.
Your name will be on the public bankruptcy register forever and there will be other personal impacts. Your bankruptcy will also be recorded on a commercial credit record for at least 5 years. You must immediately notify your trustee in writing of any change in your personal circumstances (change in name, address, income, etc).
Your trustee will charge a fee for managing your bankruptcy.
Your trustee is entitled to take a fee for managing your bankruptcy.
Generally the fee is recovered from any available assets or income contributions in the administration.

* This is an indexed amount and changes periodically. For the actual current amount, visit http://www.afsa.gov.au and look for ‘indexed amounts’. Further information about the consequences of bankruptcy is available at http://www.afsa.gov.au.If you are voluntarily applying for bankruptcy, have you considered alternative options?
• Talk to your creditors – Some creditors could give you more time to pay, agree to renegotiate repayments or accept smaller payment to settle the debt.
• Lodge a declaration of intention to apply for bankruptcy – This is an interim step that stops your creditors, the bailiff or sheriff taking action to recover unsecured debts for a period of 21 days. You could use that time to speak to your creditors, consider other options or seek advice.
• Propose and enter a debt agreement (DA) or a personal insolvency agreement (PIA) – These are legally binding agreements between you and your creditors which must be accepted by the majority of your creditors. You can offer to pay your creditors by instalments or in a lump sum which may be less than the full amount of your debts. Your level of income, debts and assets will determine whether you are eligible for a DA or a PIA.

Further information about these options is available from financial counsellors, registered trustees, registered debt agreement administrators, lawyers, accountants, or by visiting http://www.afsa.gov.au. Unless a creditor has made you bankrupt, you have the option at the time that you lodge this Bankruptcy Form of choosing to have a registered trustee administer your bankruptcy.
If you choose a registered trustee, you must speak to them before you lodge this Bankruptcy Form as they must agree to the appointment and lodge a consent to act form with the Official Receiver either before or at the same time that you lodge this form. However, if a registered trustee has not already consented to act as your trustee, the Official Receiver may, when processing your Bankruptcy Form, request that a registered trustee administer your bankruptcy. The Official Receiver will contact you to seek your consent if this is to occur.
If a registered trustee has not agreed to administer your bankruptcy, the Official Trustee will become the trustee. Note: Your trustee may change at a later date, including where creditors request a particular trustee, if a registered trustee ceases to act or a transfer between trustees occurs.

    This form incorporates Debtor’s Petition (questions 1–17 and Sections L, M and N)
    Statement of Affairs (questions 1–13, 17–59 and Sections L, M and N)
    as approved under the Bankruptcy Act 1966
    SECTION A – Your personal details and circumstances of your bankruptcy
    1.YOUR FULL NAME

    2.LIST OTHER NAMES USED IN THE LAST 10 YEARS
    (e.g. maiden name, alias)

    2A LIST OTHER NAMES USED IN THE LAST 10 YEARS

    3.DATE OF BIRTH

    4.GENDER


    FemaleMaleX

    5.THIS QUESTION IS OPTIONAL
    Are you of Aboriginal and / or Torres Strait Islander origin.


    NOYES

    6.HOME ADDRESS

    7.POSTAL ADDRESS IF DIFFERENT FROM HOME

    8.EMAIL
    Note: AFSA and/or your bankruptcy trustee will use this email to contact you

    9.PREFERRED CONTACT NUMBER

    10.LANGUAGE(S) YOU SPEAK AT HOME

    11.WHAT IS YOUR USUAL OCCUPATION
    Trade or Profession

     

    12.WHAT INDUSTRY YOU USUALLY WORK SELECT
    THE NEAREST FROM DROP DOWN MENU


    13.WHY ARE YOU COMPLETING THIS FORM-REASON
    Voluntarily-I am voluntarily becoming bankrupt select
    Court Order-Someone else made me bankrupt through a court order select


    Court OrderVoluntarily
    If through a court order supply Court Reference Number

    14.WHICH OF THE FOLLOWING APPLIES TO YOU SELECT ALL THAT APPLIES


    CURRENTLY LIVE IN

    LIVE IN AUSTRALIA

    HAVE RESIDENCE OR BUSINESS IN AUSTRALIA

    CARRY ON BUSINESS OR SOLE TRADER

    IF NONE OF THE ABOVE YOU ARE NOT ELIGIBLE TO APPLY FOR BANKRUPTCY

    15.DO YOU HAVE A ACTIVE DEBT AGREEMENT IN PLACE


    NOYES
     

    16.HOW ARE YOU APPLYING TO BECOME BANKRUPT


    individualjointlypartnership


    Separate Bankruptcy Forms must be submitted by all,
    or the majority of, partners resident in Australia

    You must attach the most recent balance sheets and
    profit and loss statements of the business
    partnership when you submit this Bankruptcy Form
     

    17.DID YOU RECEIVE ANY BANKRUPTCY INFORMATION OR ADVICE BEFORE
    COMPLETING THIS FORM


    NOYES














     

    18.WHAT DO YOU BELIEVE IS/ARE THE CAUSE/S OF YOUR INSOLVENCY
    SELECT ALL THAT APPLY
















    19.WHEN DID YOU START EXPERIENCING FINANCIAL DIFFICULTY


     

    20.HAVE YOU PREVIOUSLY BEEN BANKRUPT, OR
    HAD A DEBT AGREEMENT OR PERSONAL INSOLVENCY AGREEMENT


    NOYES
    If YES In what year(s) List the 3 most recent

    21.WHAT IS YOUR CURRENT MARITAL STATUS SELECT ONE ONLY


    SINGLE

    MARRIED



    SEPARATED

     

    22.WHAT ARE YOUR CURRENT LIVING ARRANGEMENTS


    OwnRentingBoardingEmployerFreeOther


    NOYES


    NOYES


    NOYES

    NOYES


     

    23.LIST YOUR PREVIOUS TWO RESIDENTIAL ADDRESSES
    DO NOT INCLUDE YOUR CURRENT ADDRESS
















     

    24.YOUR PASSPORT DETAILS







     

    25.HAVE YOU BEEN INVOLVED IN ANY FAMILY LAW COURT PROCEEDINGS
    OR ENTERED INTO A FAMILY LAW FINANCIAL AGREEMENT


    NOYES
    If please List the relevant dates (dd/mm/yyyy)


     

    26.CONTACT DETAILS OF SOMEONE WHO KNOWS YOU BUT DOES NOT LIVE WITH YOU
    IN THE EVENT YOUR BANKRUPTCY TRUSTEE IS UNABLE TO COMMUNICATE WITH YOU






     


    27.ARE YOU CURRENTLY EMPLOYED OR HAVE YOU BEEN EMPLOYED
    AT ANY TIME DURING THE LAST 12 MONTHS


    NOYES
    How long have you been unemployed?







    Tick if still Employed






    Tick if still Employed
     

    28.GIVE DETAILS OF THE INCOME YOU HAVE RECEIVED
    AND EXPECT TO RECEIVE FROM AUSTRALIA AND OVERSEAS

    INCOME FROM-government pensions/benefits /allowances

    INCOME FROM-salary,wages,commission,bonuses from your employer

    INCOME FROM-allowances/benefits from your employer
    (including motor vehicle and rental benefits)

    INCOME FROM-self-employment/business/contractor

    INCOME FROM-employment termination or compensation payments

    INCOME FROM-superannuation/retirement income

    INCOME FROM-dividends,rent,interest,reverse mortgages,any other investments

    INCOME FROM-any other source


     


    INCOME FROM-government pensions/benefits /allowances

    INCOME FROM-salary,wages,commission,bonuses from your employer

    INCOME FROM-allowances/benefits from your employer
    (including motor vehicle and rental benefits)

    INCOME FROM-self-employment/business/contractor

    INCOME FROM-employment termination or compensation payments

    INCOME FROM-superannuation/retirement income

    INCOME FROM-dividends,rent,interest,reverse mortgages,any other investments

    INCOME FROM-any other source


     

    29.DO YOU MAKE ANY PRE-TAX CONTRIBUTION TO SUPERANNUATIONS OR
    HAVE ANY OTHER SALARY SACRIFICE ARRANGEMENTS IN PLACE?


    NOYES

     

    30.DO YOU HAVE PRIVATE INSURANCE?


    NOYES
     

    31.DO YOU LIVE WITH ANYONE WHO RELIES ON YOU FOR FINANCIAL SUPPORT?


    noyes












     

    32.DO YOU EXPECT TO PAY ANY CHILD SUPPORT IN THE NEXT 12 MONTHS UNDER

    Child Support (Assessment) Act 1989 or the Family Law Act 1975?

    noyes


     

    33.DO YOU EXPECT TO RECEIVE A TAX REFUND


    NOYES
    IF YES Give details
    Financial year



    Amount you expect to receive


    Financial year


    Amount you expect to receive


    Financial year


    Amount you expect to receive


     

    34.GIVE DETAILS OF YOUR UNSECURED DEBTS IN AUSTRALIA AND OVERSEAS
    A CREDITOR IS WHO YOU OWE THE DEBT TO.
    AN UNSECURED DEBT IS A DEBT NOT BACKED BY AN ASSET (eg CREDIT CARD, TAX DEBT, PERSONAL LOAN)
    AN UNSECURED CREDITOR DOES NOT HAVE THE RIGHT TO REPOSSESS AND SELL AN ASSET IF YOU ARE UNABLE TO PAY THEM WHAT YOU OWE.
    A RELATED ENTITY INCLUDES A RELATIVE, OR A COMPANY IN WHICH YOU OR A RELATIVE ARE A DIRECTOR, OR A TRUST IN WHICH YOU OR A RELATIVE ARE A BENEFICIARY OR TRUSTEE.
    A PARTNERSHIP IN WHICH YOU OR A RELATIVE ARE A MEMBER.
    THE FULL DEFINITION OF RELATED ENTITY IS EVEN BROADER THAT THIS.












    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT













    ARE YOU RELATED TO THE CREDITOR

    IS THE DEBT A JOINT DEBT

     

    35.IN THE LAST 12 MONTHS HAVE YOU PAID A CREDITOR
    MORE THAN $1,000 OVER AND ABOVE YOUR NORMAL REPAYMENTS

    NOYES








































     

    36.IN THE LAST 12 MONTHS HAVE YOU SURRENDERED ANY ASSETS TO A CREDITOR OR HAS A CREDITOR REPOSSESSED ANY ASSETS?

    NOYES






    If the asset is:
    • real estate – provide the address
    • a vehicle – provide the registration number
    • other – give details




    Date surrendered / repossessed (dd/mm/yyyy)


    NOunknownYES
    __________________________________________________________





    If the asset is:
    • real estate – provide the address
    • a vehicle – provide the registration number
    • other – give details




    Date surrendered / repossessed (dd/mm/yyyy)


    NOunknownYES
    __________________________________________________________





    If the asset is:
    • real estate – provide the address
    • a vehicle – provide the registration number
    • other – give details




    Date surrendered / repossessed (dd/mm/yyyy)


    NOunknownYES
    __________________________________________________________





    If the asset is:
    • real estate – provide the address
    • a vehicle – provide the registration number
    • other – give details




    Date surrendered / repossessed (dd/mm/yyyy)


    NOunknownYES
    __________________________________________________________





    If the asset is:
    • real estate – provide the address
    • a vehicle – provide the registration number
    • other – give details




    Date surrendered / repossessed (dd/mm/yyyy)


    NOunknownYES
    __________________________________________________________
     

    SECTION D – Your money and general personal assets Note:
    In questions 37–50 you must record all assets held both in Australia and overseas.
    37.How much cash (notes and coins) do you have, excluding money in bank accounts?


     

    38 Give details of all your bank, building society,credit union etc. accounts,including accounts closed in the last 12 months
    Note: Don’t include loan or credit card accounts here.
    Put them at question 34.
    Name of financial institution











    Name of financial institution










    Name of financial institution










    Name of financial institution










    Name of financial institution










    Name of financial institution











     

    39.Give details of all your superannuation accounts








    SMSF







    SMSF







    SMSF
     

    40 Do you own, or are you entitled to, any shares?
    No Tick NO Go to question 41
    Yes Give details


    NOYES



































     

    41.Do you own any vehicles including cars, motorbikes, trailers, caravans, campervans, boats or other means of transport?
    No Tick NO Go to question 42
    Yes Give details


    NOYES













    NOYES










    ___________________________________________________________________________













    NOYES










    ___________________________________________________________________________













    NOYES









     

    ___________________________________________________________________________
    42 Do you own any jewellery, artwork, antiques, collectables, timeshare, copyrights, patents, trademarks, work tools or livestock/animals valued at over $2,000?
    No Tick NO Go to question 43
    Yes Give details


    NOYES








    ___________________________________________________________________________








    ___________________________________________________________________________








    ___________________________________________________________________________








    ___________________________________________________________________________
    Note: Any other unsecured or secured debt(s) should be listed when you reach question 50
    ___________________________________________________________________________
     

    ___________________________________________________________________________
    43 Do you expect to receive a distribution from a deceased estate
    (e.g. you are receiving an inheritance under a will)?
    No Tick NO Go to question 44
    Yes Give details


    NOYES











     

    44 Do you have any interest in real estate (e.g. a house, a unit, a commercial property, block of land)
    whether you are a registered owner or not?
    No Tick NO Go to question 45
    Yes Give details


    NOYES







    NOYES







    NOYES





    NOYES





    NOYES





























    E_RE_LoanMortgagee_2





     

    SECTION F – Other financial assets
    45 Do you have any managed investments, such as interest in mutual funds or other investments?
    No Tick NO Go to question 46
    Yes Give details


    NOYES

















     

    46 Do you own, or are you entitled to, any digital assets
    (e.g. digital currency such as Bitcoin)?
    No Tick NO Go to question 47
    Yes Give detail


    NOYES











     

    47.Do you have any accounts (other than bank accounts, digital assets or other accounts already disclosed)
    where money or value is stored (e.g. Tabcorp, Sportsbet, PayPal or similar)?
    No Tick NO Go to question 48
    Yes Give details


    NOYES































     


    48.Does anyone owe you money, including public/private companies,
    friends, relatives or family trusts?
    No Tick No Go to question 49
    Yes Give detail


    NOYES









































     

    Note: If you are owed money by more than 4 people,call or email us 1300 861 455

    Assets owned by others that you have contributed to
    49. Have you contributed to the value of $5,000 or
    more to the purchase or improvement of any asset owned by someone else, including through cash and /
    or other forms of non-financial contribution
    (e.g. contribution to purchase price, paying ongoing expenses, assisting renovations)?
    No Go to question 50
    Yes Give details


    NOYES







































     


    NOYES









    NOYES

















    NOYES







     


    NOYES



























































     


    NOYES



































     


    NOYES

















    NOYES







    NOYES











    NOYES



















































    NOYES



















    NOYES













    NOYES





























     


    NOYES










    Director

    Current Shareholder

    Previous Director

    Previous Shareholder

    Other



    ceasedcurrentlyliquidationnever













    administratorliquidatorreceiver





    NOYES

    NOYES



    NOYES







     


    NOYES




    Beneficiary

    Unit Holder

    Trust Trustee




    NOYES





    NOYES























    NOYES





    NOYES





    NOYES



     


    NOYES

    Recovery

    Family Law

    Contract

    Personal Injury

    Creditor's petition

    Other Give Details



    applicant/plaintiffdefendant/respondentotherthird party















     

    Note: If you have been involved in more than one legal action, download, complete and attach further pages call 1300 861 455.


    NOYES











    abel>Who has possession of the asset 1










     


    NOYES


























     

    SECTION L – Declaration of applicant – ONLINE LODGEMENTS ONLY
    With the exception of your name, the information in this section will not be accessible by the public.







    L_Declaration_ReadPrescibed


    L_Declaration_Correct


    behalfmailonline






    M_Declaration_ReadPrescibed


    M_Declaration_Correct






    N_Declaration_1


    N_Declaration_2


    N_Declaration_3


    N_Declaration_4






     

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