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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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