Online Bankruptcy Form

The interface below once completed will fill both forms Debtors Partition and Statement of Affairs required to become bankrupt in PDF document and we will send it to you.

Not every question will be relevant to your personal situation.
Where a question is required and not answered the interface will redirect you to the question and it must be answered.
Or you can call us and we can advise what needs to be done.

If its overwhelming and stressful we can lodge the complex paperwork for you (80 pages) however we will apply an administration fee.

Don’t waist your money and time, get a fresh start, what are you waiting for!!

DEBTOR’S PETITION (APPLICATION TO BECOME BANKRUPT) Bankruptcy Act 1966 Section 55(2) The information you add is part of the official information the AFSA requires.

This ONLINE Bankruptcy interface has a number of questions the Government requires for you to become bankrupt, questions with the HIGHLIGHTED asterisk red * are required fields, not all questions will be relevant to your situation.
PLEASE READ EACH QUESTION CAREFULLY AS YOU ARE REQUIRED BY LAW TO ANSWER QUESTIONS TRUTHFULLY.

YOU CAN START YOUR FORM AND SAVE IT AND COME BACK AT ANOTHER TIME TO COMPLETE.
WE CAN ASSIST YOU ALSO IF YOU HAVE ANY QUESTIONS.
Create a login and save your password it allows you to save and come back and complete your form.

Password*

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Confirm Password*

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Title Mr/Mrs/Ms/Miss*

Contact Details--GIVEN NAME/S (include all names)*

YOUR CURRENT NAME.

SURNAME*

SURNAME YOU USE NOW.

Title-IF YOU HAVE USED OTHER NAMES IN THE PAST 10 YEARS.

Title.

OTHER NAMES USED PAST 10 YEARS-GIVEN NAME/S (Include all names)

USE THIS FIELD IF YOU HAVE USED ANOTHER NAME IN THE LAST 10 YEARS OTHERWISE LEAVE BLANK.

NAME USED IN LAST 10 YEAR-Surname.

Other surname names used in the last 10 years

Title -IF YOU HAVE USED OTHER NAMES IN THE PAST 10 YEARS

IF YOU HAVE USED OTHER NAMES IN THE PAST 10 YEARS-given name/s (include all names)

Given Names.

NAME USED IN LAST 10 YEARS-SURNAME

Other surname used in last 10 years.

YOUR Contact number(include area code)

Phone Number land line..

YOUR Work number(include area code)

Phone number include area code.

YOUR Mobile

Mobile number.

YOUR Email address

Valid email address

YOUR Address*

Current residential address.

Post code*

Current occupation*

Your occupation or if not working note unemployed.

Date of birth (DD/MM/YYYY)*

Date of birth (DD/MM/YYYY)

To be eligable to present this partition you must have a relevant Australian connection.Select the statement that describes your connection to Australia.*

I am personally present in Australia or ordinarily resident in Australia

I have a dwelling-house or place of business in Australia

I or my firm/partnership is carrying on business in Australia

Select one that applies to you. must select one.

I am presenting this debtor’s petition to become bankrupt (select one of the following):*

as an individual debtor

against a business partnership of which I am a partner all and majority needs to be submitted together

jointly with another person and we are not in a business partnership (petition by other person needs to be submitted also)

Select the one that applies to you, must select one.

PROOF OF IDENTITY Note: your petition will not be accepted if you do not provide appropriate proof of identity details below. While identification information is required for acceptance of your partition, you are NOT required to attach copies of the acceptable forms of identification with your partition.*

A: Type of identification

Your Name on licence

Licence number

Type of Identification.*

Include all numbers.

Your Name on Medicare card as its written on card all names*

Medicare Card number

If the name on your identification in any of the above differ please explain why.

Declaration of Person who Assisted with the Completion of Forms: I declare that, before this form was completed, I carefully read to/interperated for the person named in the Contact Details section the perscribed information and the questions on the form or[where the person is physically incapcitated] satisfied myself that the person had read and understood the information and questions. The responses provided in this form are those named above.

Reason the debtor required your assistance

Full Name and address of the assisting person

Signature of the assisting person

Date (DD/MM/YYYY)

I Acknowledge that I have Received and Read the Prescribed Information

Your signature this will be signed once documents are sent to you , if you have electronic signature sign.

Date (DD/MM/YYYY)

1-STATEMENT of AFFAIRS Title Mr/Mrs/Ms*

1.1-Given Names*

Given name/s (include all names)

1.2-Surname*

Your surname

1.3-Additional Notes

1.4-Your Personal Details -Home telephone number

Include area code

1.5-Work number (include area code)

Include area code.

1.6-Mobile Number

1.7-Fax Number

1.8-Email address

Your email address.

1.9-Do you prefer to receive correspondence by email where possible*

YES

1.10-NAME AND ADDRESS OF A CONTACT PERSON WHO DOES NOT LIVE WITH YOU*

This is used if you are not able to be contacted

1.11-NAME AND ADDRESS OF A CONTACT PERSON WHO DOES NOT LIVE WITH YOU*

Given name/s (include all names)

1.12-Surname*

Surname.

1.13-The Address of the person who does not live you.*

1.14-Post code*

1.15-Mobile/Contact number(include area code)*

1.16-Their Relationship to you.*

Mother,brother or friend.

1.17-Do you have a passport/s?*

YES

If YES please give details.

1.18-If so how many? Please give details.

Number of passports.

1.19-Passport Number and expiry date #1

1st Passport Number and expiry dd/mm/yyyy

1.20-Passport Country of issue #1

1st Passport country of issue.

1.21-Passport Number and expiry date #2

2nd Passport Number and expiry dd/mm/yyyy

1.22-Passport Country of issue #2

2nd Passport country of issue

1.23-Do you have a current drivers licence

YES

If YES please give details.

1.24-Licence Number

Number on your licence.

1.25-Expiry Date

DD/MM/YYYY

1.26-State of Issue

Drop down select.

1.27-Other

1.28-Are you of Aboriginal or Torres Strait Islander Origin? (Optional)

YES

Optional

1.29-Were you born overseas? (optional)

YES

Optional.

1.30-Which Country? (optional)

Optional.

1.31-What languages do you speak at home (optional)

Optional.

2.Do you have an accountant*

NO go to Q3

YES

If yes please give detail.

2.1-Accountant Firm Name

2.2-Accountant Contact Person

2.3-Accountant Phone Number

2.4-Accountant Address

Address.

2.5-Accountant Post Code

Post Code.

3-Do you have a solicitor*

NO go to Q4

YES

If YES please give details.

3.1-Solicitor firm name

3.2-Solicitor contact person

3.3-Solicitor Phone Number

3.4-Solicitor Address

Address.

3.5-Solicitor postcode

Post Code.

4-About your family- Do you have a spouse/partner*

NO go to Q5

YES

If YES please give details.

4.1-Your spouse/partner’s full name

4.2-Do you live with your spouse/partner?

YES

4.3-Spouse/Partner separate gross income ($) per YEAR

4.4-Spouse/partner’s separate gross income ($) WEEK

4.5-Do you have any dependants residing with you? (eg spouse, children, parents, invalid relative)

YES

4.6-Dependent #1 Full name

Name.

Dependent #1 Relationship

Relationship to you.

Dependent #1 Date of birth

dd/mm/yyyy

Dependant #1 Separate income($)

If applicable $

4.7-Dependent #2 Full name

Name

Dependent #2 Relationship

Relationship to you.

Dependant #2 Date of birth

dd/mm/yyyy

Dependant Separate income #2 ($)

If applicable $

4.8-Dependant #3 Full Name

Name.

Dependant #3 Relationship

Relationship to you.

Dependant #3 Date of birth

dd/mm/yyyy

Dependent #3 Separate income($)

If applicable $

4.9-Dependant #4 Full Name

Name.

Dependant #4 Relationship.

Relationship to you.

Dependant #4 Date of birth

dd/mm/yyyy

Dependant #4 Separate income($)

If applicable $

4.10-Dependant #5 Full name.

Name.

Dependant #5 Relationship.

Relationship to you.

Dependant #5 Date of birth.

dd/mm/yyyy

Dependant #5 Separate income.

4.11-Dependant #6 Full name.

Name.

Dependant #6 Relationship.

Relationship to you.

Dependant #6 Date of birth.

dd/mm/yyyy

Dependant #6 Separate income.

4.12-Dependant #7 Full name.

Name.

Dependant #7 Relationship.

Relationship to you.

Dependent #7 Date of birth.

dd/mm/yyyy

Dependant #7 Separate income.

If applicable $

5-Child Support: In the next 12 months, do you expect to pay or receive any finacial support under the Child Support (Assessment) Act or the Family Law Act 1975? Please give details and provide a copy of the assessment order*

NO go to Q6

YES

Please give details and provide acopy of the assessment or order

5.1-IF YOU PAY CHILD SUPPORT/MAINTENANCE.

I Pay child support/maintenance

5.2-CHILD SUPPORT PAID TO.

Persons name.

5.3-PAID CHILD SUPPORT AMOUNT($)

5.4-PAID FREQUENCY.

weekly/fortnightly or monthly.

5.5-IF YOU RECEIVE CHILD SUPPORT/MAINTENANCE.

I Receive child support/maintenance.

5.6-RECEIVED FROM.

Persons name.

5.7-RECEIVED AMOUNT.

5.8-FREQUENCY.

Weekly/fortnightly or monthly.

6-Family Law (FL) Financial Proceedings: Have you been a party to a family law property or spousal maintenance order or agreement? if yes, Please provide a copy of the agreement or order*

NO go to Q7

YES

If YES Please provide a copy of the agreement ororder

6.1-FL- Date of the Order

dd/mm/yyyy

6.2-FL-Are you currently involved in any family law property or spousal maintenance proceedings?

YES

If YES Please provide a copy of the application. Donot include proceedings for custody of children

6.3-FL-Are you likely to become involved in any such proceedings?

YES

7-Legal Action-:Are you involved in any legal processes or disputes?*

NO Go to Q8

YES

If YES Please provide a copy of the agreement ororder

7.1-Legal Action-#1 Plaintiff

Name

7.2-Legal Action-#1 Defendant

Name.

7.3-Legal Action-#1-Court

Name

7.4-Legal Action-#1 Plaint no.

Plaint Number on document.

7.5-Legal Action-#2 Plaintiff

Name.

7.6-Legal Action-#2 Defendant

Name.

7.7-Legal Action-#2 Court

Name

7.8-Legal Action-2# Plaint no.

Plaint number on court document.

7.9-Legal Action-#3 Plaintiff

Name.

7.10-Legal Action-#3 Defendant

Name.

7.11-Legal Action-#3 Court

Name.

7.12-Legal Action-#3 Plaint no

Plaint number on Court document.

8-Proceeds of Crime Orders-Are you or your property subject to a proceeds of crime order or an application for a proceeds of crime order?*

NO go to Q9

YES

If YES Provide a copy of the order.

9-SUMMARY OF YOUR INCOME IN THE LAST 12 MONTHS

Add Below

9.1- INCOME FROM PENSION/CENTRELINK PAST 12 Months

If Pension or Centrelink Name of Government Benefit.

Amount from Gov benefit $ over past 12 months.

Provide details of your income (before tax) over the past 12 months.

9.2-SELF EMPLOYED:Business name

Name of your SELF EMPLOYED BUSINESS

Self Employed Income $

Provide details of your income (before tax) over the past 12 months.

9.3-BUSINESS: Name

Name of your business.

Business Income $

Provide details of your income (before tax) over the past 12 months.

9.4-GROSS WAGES: Employer name

Your income (before tax) over the past 12 months.

GROSS WAGES SALARY.

Provide details of your income (before tax) over the past 12 months.

9.5-SUPERANNUATION retirement fund

Fund Name

SUPER AMOUNT

Provide details of your income (before tax) over the past 12 months.

9.6-LUMP SUM TERMINATION

Received from Company name.

LUMP SUM AMOUNT payout figure

Provide details of your income (before tax) over the past 12 months.

9.7-If Deceased estate/trusts.

Received from:

If Deceased estate $ Amount:

Amount given from estate or trust $

9.8-INCOME FROM INVESTMENTS.

Name of Investments/shares/trust/interest.

Dollar value Income from investments (eg dividends, interest, trusts).

Provide details of your income (before tax) over the past 12 months.

9.9-Income from reverse mortgages Received from:

Name.

Amount $ received from reverse mortgages:

Amount $ received.

9.10-Name of source Received from any other income:

Name of income source

Amount $ received from any other source:

Provide details of your income (before tax) over the past 12 months.

9.11-TOTAL OF YOUR INCOME FROM ALL SOURCES $

Value of total income received.You must provide evidence of your income to your trustee (eg payslips, tax returns, statements) on the anniversaryof your bankruptcy and when your income changes

10.1-SUMMARY OF YOUR EXPECTED INCOME IN THE NEXT 12 MONTHS.

Payment type example- Newstart. Pension

Expected Pension next 12 months.

$ Amount expected in the next 12 months.

10.2-SELF EMPLOYED: Business name:

Name of your business.

Income from your SELF EMPLOYED BUSINESS

$ details of your income (before tax) that you expect to receive in the next 12 months.If you are not sure, please estimate.

10.3-BUSINESS NAME

Name of your business

INCOME EXPECTED NEXT 12 MONTHS BUSINESS.

$ details of your income (before tax) that you expect to receive in the next 12 months.If you are not sure, please estimate.

10.4-GROSS WAGES EMPLOYERS NAME.

Name of your employer.

GROSS WAGES SALARY NEXT 12 MONTHS

Your expected income from your employer in the next 12 months.

10.5-If RETIRED Name of SUPERANNUATION retirement fund

Name of Fund.

SUPER AMOUNT EXPECTED NEXT 12 MONTHS.

Provide details of your income (before tax) over the next 12 months.

10.6-LUMP SUM TERMINATION TO BE RECEIVED FROM.

Name

LUMP SUM AMOUNT PAYOUT FIGURE NEXT 12 MONTHS.

Provide details of your income (before tax) over the next 12 months.

10.7-IF DECEASED ESTATE /TRUST NAME.

Name

DECEASED RECEIVED AMOUNT NEXT 12 MONTHS.

$ Provide details of your income (before tax) over the next 12 months.

10.8-INCOME FROM INVESTMENTS NEXT 12 MONTHS

:Name of investments (eg dividends, interest, trusts) Received from:

DOLLAR VALUE FROM INVESTMENTS

Income from investments (eg dividends, interest, trusts) $ Provide details of your income (before tax) over the next 12 months.

10.9-REVERSE MORTGAGES NEXT 12 MONTHS.

Name of bank or company.

AMOUNT $ REVERSE MORTGAGES.

Provide details of your income (before tax) over the next 12 months.

10.10-NAME OF SOURCE RECEIVED OTHER INCOME NEXT 12 MONTHS.

Name

AMOUNT RECEIVED $

$ Provide details of your income (before tax) over the next 12 months.

10.11-TOTAL AMOUNT RECEIVED NEXT 12 MONTHS.

$ Value of total income received.You must provide evidence of your income to your trustee (eg payslips, tax returns, statements) on the anniversaryof your bankruptcy and when your income changes

11 Employment status- Are you currently employed?*

NO give details below.

YES go to Q12

11.1-How long have you been unemployed?- YEARS

11.2-How long have you been unemployed?- MONTHS

11.3-What was your occupation when you were last employed?-GO TO Q15

12-YOUR CURRENT EMPLOYMENT- JOB1

NAME OF YOUR CURRENT EMPLOYER.

12.1 -EMPLOYER ADDRESS-JOB1

Address

12.2 YOU ARE EMPLOYED AS-JOB1

What are you employed as.

12.3-TYPE OF INDUSTRY-JOB1

Industry you work in.

12.4-PAY PERIOD-JOB1

week/fortnight/monthly

12.5-HOURS DO YOU WORK PER WEEK-JOB1

Hours worked per week.

12.6 Is your employer a related entity?-JOB1

YES

Are you related in any way to your employer. If you are unsure whether your employer is related, please refer to the instructions in the front of this booklet beforeanswering this question.

12.7-CURRENT EMPLOYMENT-JOB2

NAME OF YOUR EMPLOYER -JOB2

12.8 -EMPLOYER ADDRESS-JOB2

Address

12.9-EMPLOYED AS-JOB2

Name.

12.10-TYPE OF INDUSTRY-JOB2

Industry you work in.

12.11-PAY PERIOD -JOB2

Week/fortnight/monthly

12.12-HOURS DO YOU WORK-JOB2

Hours worked per week.

12.13 Is your employer a related entity? JOB2

YES

Are you related in any way to your employer. If you are unsure whether your employer is related, please refer to the instructions in the front of the AFSA booklet beforeanswering this question.

12.14-EMPLOYMENT INCOME-JOB1

GROSS $ FIGURE IN NEXT BOX BELOW.

12.15-GROSS PAY PER PERIOD-(BEFORE TAX)-JOB1

GROSS PER PAY PERIOD-WEEKLY FORTNIGHTLY OR MONTH

12.16-DEDUCTIONS-JOB1

DOLLAR FIGURE IN NEXT BOX BELOW

12.17-INCOME TAX-JOB1

12.18-GARNISHEES BY CREDITORS-JOB1

12.19-SUPERANNUATION-JOB1

12.20-MAINTENANCE/CHILD SUPPORT-JOB1

12.21-OTHER-JOB1

12.22-TOTAL DEDUCTIONS-JOB1

12.23-WHAT IS YOUR NET PAY?-JOB1

UPLOAD CURRENT PAYSLIPS AS SUPPORTING DOCUMENTATION AT THE END OF THE PAGE.

12.24-EMPLOYMENT INCOME -JOB2

DOLLAR FIGURE IN NEXT BOX BELOW

12.1.10-JOB2 GROSS PAY PERIOD (BEFORE TAX)

12.26-DEDUCTIONS-JOB2

FIGURE IN BOXS BELOW

12.27-INCOME TAX-JOB2

12.28-GARNISHEES BY CREDITORS-JOB2

12.29-SUPERANNUATION-JOB2

12.30-MAINTENANCE/CHILD SUPPORT-JOB2

12.31-OTHER-JOB2

12.32-TOTAL DEDUCTION-JOB2

12.33-WHAT IS YOUR NETT PAY-JOB2

UPLOAD CURRENT PAYSLIP AS SUPPORTING DOCUMENTATION AT THE END OF THE PAGE

13 PRIVATE HEALTH COVER

YES

Do you have private patient hospital cover?

14 SALARY SACRIFICE*

NO go to Q15

YES

Is your salary now or at any time in the last 2 years subject to a SALARY SACRIFICE arrangement ( that is, you have given up cash wages for another type of non-cash benefit)

14.1 SALARY SACRIFICE- Details

Provide detail of salary sacrifice.

15 SUPERANNUATION BENIFITS*

NO go to Q16

YES (Please give details)

Does any party make a superannuation contribution for you?

15.1 Name and address of the person making the payment

Name and the address of the person/company making super payments

15.2 Where is it paid to?

Name of Super Fund

15.3 How much is paid? ($ per week)

Amount Paid per week.

15.1 Name and address of the person making the payment FUND 2

Name and the address of the person/company making super payments

15.2 Where is it paid to? FUND 2

Name of Super Fund. #2

How much is paid? ($ per week) FUND 2

16 OTHER BENIFITS*

NO go to Q17

YES (please give details)

Do you, or any member of your family, receive or expect to receive any benefit from any other person or entity? (include rent, low interest loans, payment of your expenses or children's education)interest loans, payment of your expenses or children’s education)

16.1 Detail of benefit.

16.2 Type of Benefit #1

16.3- Name of person giving benefit #1

Name.

16.4-Name of person receiving benefit #1

16.5 Value of benefit per year ($) benefit #1

16.6 Your contribution per year ($)

16.7 Type of Benefit #2

16.8- Name of person giving benefit #2

16.9-Name of person receiving benefit #2

16.10 Value of benefit per year ($)

16.11-Your contribution per year ($)

17. MOTOR VEHICLE BENEFITS-Do you use a vehicle which is owned by someone else?*

NO go to Q18

YES please give details below

17.1 Owner’s name and address

17.2 Relationship (eg employer/spouse)

Who owns the vehicle you are using.

17.3 When did the owner purchase the vehicle?

dd/mm/yyyy

17.4 Make of vehicle

Toyota,Holden,Ford ect.

17.5 Model

Corolla, Berlina, Focus ect.

17.6 Year of Manufacture

Year made.

17.7 How much do you contribute for the use of the vehicle? ($)

17.8 How many days per week do you have the vehicle?

Days

17.9 How many kilometres do you travel per week?

kms.

18.1- ABOUT YOUR INSOLVENCY-What do you believe is the main cause of your insolvency? Tick one cause in either that best describes the main causes of your financial difficulties.*

Unemployment or loss of income

Adverse legal action

Liabilities due to guarantees

Gambling, speculation & extravagance in living

Ill health or absence of health insurance

Domestic discord or relationship breakdowns

Excessive use of credit facilities including losses on repossessions, high interest payments and pressure selling

Non-business related

18.3-If other reason not listed, please specify:

18.4-When did you first have difficulty paying your debts?(month/year)*

mm/yyyy

18.6- Have you previously presented a declaration of intention to present a debtor’s petition, proposed or entered into a debt agreement or a personal insolvency agreement or become bankrupt?*

NO Go to Q19

YES (Please provide Administration number below)

Have you been bankrupt before.

18.7-Bankruptcy Administration number

Document number.

18.8-Year of bankruptcy

yyyy

18.9-HAVE YOU ENTERED IN A- Part IX(9)debt agreement if so provide administration number.

Number.

18.10-Part IX(9) debt agreement Year

yyyy

18.11-HAVE YOU ENTERED IN A-Part X personal insolvency agreement administration number.

Number.

18.12-Part X personal insolvency agreement year

yyyy

18.13-HAVE YOU PRESENTED A-Declaration of Intention to present a debtor’s petition Administration number

Number.

18.14-Declaration of Intention to present a debtor’s petition year.

yyyy

Blank page for information

19- About You-PART B – PERSONAL DETAILS -*

MALE

FEMALE

Gender

19.1-Date of birth*

DD/MM/YYYY

19.3-Family name*

Surname.

19.4-Given names*

First and middle names.

19.5-List all other names you have used in the last 10 years

Name.

19.6-Residential address*

Address.

19.7-Postcode*

Number.

19.8-Do you own or are you buying this property?*

YES ( Please give detail at Q28)

19.9-If no to the question above, are you renting this property?*

YES

19.10-Postal address.*

Address.

19.11-Postcode*

Number.

19.12-Previous two residental addresses.Address 1*

Address.

19.13 Postcode*

Number.

19.14-Did you own or are you buying this property?*

YES

19.15-Address 2*

Address you lived at before address 1.

19.16-Address 2 Postcode*

Number.

19.17-Address 2 Did you own or were you buying this property?*

YES if yes provide date below.

19.18-Address 2 Date sold

dd/mm/yyyy

20-Occupation What is your usual trade or profession?*

Job Name.

21-Business-In the past 5 years have you operated a business as a sole trader, via a partnership, via a company or a trust?*

NO go to Q22

YES (provide details in Part E)

22-PART C -YOUR PUBLIC ASSETS-Cash-How much cash do you have? (include cash at bank at Q23)*

This figure is to be added to what you have in the Q23 Savings account below, should include all cash on your person ( wallet/purse).

23-NAME of Banks/Building Societies/ Credit Unions/Other Financial Institutions

List all accounts held (include joint and overdrawn accounts) with any of the above types of institutions within thelast 12 months. (Note: presently overdrawn accounts should also be included as creditors at Q40)

23.1-Branch Name

Suburb.

23.2-Account Number/account type.

Number/Name

23.3-Current Balance $

23.4-Joint account

YES

23.5-NAME of Banks/Building Societies/ Credit Unions/Other Financial Institutions

23.6-Branch Name

Suburb.

23.7-Account Number and account type

Number/name.

23.8-Current Balance $

23.9-Joint account

YES

23.10-NAME of Banks/Building Societies/ Credit Unions/Other Financial Institutions

23.11-Branch Name

Suburb.

23.12-Account number and account type

Number/name.

23.13-Current Balance $

23.14-Joint account

YES

23.15-NAME of Banks/Building Societies/ Credit Unions/Other Financial Institutions

23.16-Branch Name

Name or Online.

23.17-Account number and account type

Number/Type

23.18-Current balance ($)

23.19-Joint Accounts

YES

24- TAX Refund- Do you expect a refund*

NO go to Q25

YES (please give details)

24.1-Year ending

30 June YYYY

24.2-Amount expected ($)

24.3-Year ending

30 June yyyy

24.4-Amount expected ($)

25-Tools of Trade- Do you have tools of trade?*

NO go to Q26

YES (please give details below)

25.1-What is their estimated resale value? ($)

26.1- Superannuation and Life Insurance Policies: List all superannuation funds and life insurance policies

Name of fund

26.2-Is this a regulated fund?

YES

26.3-Balance of fund ($)

26.4-Type of fund

SUPER

LIFE

26.5- Superannuation and Life Insurance Policies

List all superannuation funds and life insurance policies

26.6-Is this a regulated fund?

YES

26.7-Balance of fund ($)

26.8-Type of fund

SUPER

LIFE

26.9- Name of Fund

Name.

26.10-Is this a regulated fund?

YES

26.11-Balance of fund

Amount $

26.12-Type of fund.

Super

Life

26.13-Have you received a superannuation payout from any fund in the last 5 years?

YES (Please give detail)

26.14-Date received

dd/mm/yyyy

26.15-Amount received

26.16-Have you made a lump sum payment to any superannuation fund in the last 5 years?

YES (Please give details)

26.17-Date paid

dd/mm/yyyy

26.18-Amount paid

26.19-Do you expect receive payment from any superannuation fund in the next 3 years?*

YES

27-Vehicles-Do you own, or have an interest in any vehicles? (this includes cars, motor bikes, trailers, caravans, campervans, boats)*

NO go to Q28

YES

27.1-Type of vehicle (eg car, boat)

Car,boat,caravan,trailer,motorbike,jetboats.

27.2-Make

Holden, Toyota, Mazda ect.

27.3-Model

Corolla,Berlina, Focus ect.

27.4-Year

Year of Manufacture

27.5-Registration number

Rego plate number.

27.6-Estimated resale value ($)

27.7-Amount owed (if any) ($)

27.8-Type of vehicle (eg car, boat)

Car,boat,caravan,trailer,motorbikes,jetboats.

27.9-Make

Holden, Toyota, Mazda ect.

27.10-Model

Corolla, Berlina, Focus ect.

27.11-Year

Year of Manufacture.

27.12-Registration number

Rego plate number.

27.13-Estimated resale value ($)

27.14-Amount owed (if any) ($)

28.1-Real Estate-Do you own, or are you buying, any land or buildings in Australia or overseas? (This includes any interest in vacant land, house, unit, commercial property)*

NO-Go to Q29

YES (please give details)

28.2-Is there a building on the land?

YES - please give details

28.3-Type eg house/unit

House/Unit.

28.4-Age of building.

When was the building constructed.

28.5-Number of bedrooms

Number.

28.6-Number of bathrooms

Number.

28.7-What is the property address?

Address.

28.9-Date the property was acquired or purchased

dd/mm/yyyy

28.10-Amount paid to acquire or purchase the property ($)

28.11-What is the estimated resale value of the property? ($)

28.12-How much do you owe to creditors who hold security over this property? ($)

28.13-Are there any other owners?

YES -please give details

28.14-Owner 1 Name

Name.

28.15-Owner 1 Address

Address.

28.16- Owner 2

Name

28.17-Owner 2 Address

Address.

28.18-Is the property vacant?

YES

28.19-Do you live at the property?

YES

28.20-Does your partner live at the property?

YES

28.21-Is the property rented to tenants?

YES please give details

Below rent, who collects rent.

28.22-Gross rent per week ($)

28.23-Name of person collecting rent

Name.

28.24-Address of person collecting rent.

Name.

28.25-Is the property listed for sale?

YES please give details

Below.

28.26-Agents name.

Name of real estate.

28.27-Agents Address

Address.

28.28-Is the property insured?

YES provide expiry date below.

Date below

28.29-Insurance Expiry date

dd/mm/yyyy

29-SHARES Do you own, or are you entitled to any shares, options, rights, convertible notes or other securities?*

NO go to Q30

YES please give details

Do you own, or are you entitled to any shares, options, rights, convertible notes or other securities?

29.1-Name of address of company.

Name and address of company

29.2-Number of shares

Number.

29.3-Shareholder number

Number.

29.4-Date acquired

dd/mm/yyyy

29.5-Market value ($)

29.6-Note: Do any of the above shares have any restrictions on their sale? (Eg certain types of employee shares cannot be sold for a specific period) Sales restriction write "R"

If restrictions apply put 'R' here.

29.7- Name of address of company.

Name and address of company

29.8-Number of shares

Number.

29.9-Shareholder number

Number.

29.10-Date acquired

dd/mm/yyyy

29.11-Market value ($)

Note: Do any of the above shares have any restrictions on their sale? (Eg certain types of employee shares cannot be sold for a specified period) If there are any sal restrictions, please write 'R' in below.

29.12-Note: Do any of the above shares have any restrictions on their sale? (Eg certain types of employee shares cannot be sold for a specific period) Sales restriction write "R"

29.13-Name and address of company.

Name.

29.14-Number of shares.

Number.

29.15-Shareholder number.

Shareholder number the identification of shares.

29.16-Date acquired

dd/mm/yyyy

29.17-Market Value ($)

29.18-Note: Do any of the above shares have any restrictions on their sale? (Eg certain types of employee shares cannot be sold for a specific period) Sales restriction write "R"

If restricted shares write 'R' here.

30-INVESTMENTS*

NO go to Q31

YES please give details

Do you have any managed investments, insurance bonds, debentures orother investments?

30.1-Investment type

Name.

30.2-Date acquired.

dd/mm/yyyy

30.3 Market Value ($)

30.4-Investment type.

Name.

30.5-Date acquired.

dd/mm/yyyy

30.6-Market value ($)

30.7-Investment type.

Name.

30.8-Date acquired.

dd/mm/yyyy

30.9-Amount owed ($)

31- MONEY OWED TO YOU.*

NO go to Q32

YES please give details

Do you have any debts owed to you? (include loans to friends and relatives and to family trusts or private companies; do not include child support arrears)

31.1-Name and address of person or organisation who owes you money

Name and address.

31.2-Date debt was created

dd/mm/yyyy

31.3-Amount owed ($)

31.4-Amount likely to be received ($)

31.5-Name and address of person or organisation who owes you money

Name/address.

31.6-Date debt was created

dd/mm/yyyy

31.7-Amount owed ($)

31.8-Amount likely to be received ($)

31.9-Name and address of person or organisation who owes you money

Name/address.

31.10-Date debt was created

dd/mm/yyyy

31.11-Amount owed ($)

31.12-Amount likely to be received ($)

32 DECEASED ESTATE- Have you received and interest (money or benefit) in a deceased estate.*

NO go to Q33

YES please give details

Do you have an interest in a deceased estate? Provide a copy of the will or letters from the executor

32.1-Name of deceased

Name.

32.2-Date of death

dd/mm/yyyy

32.3-Executor name and address

Name/address.

32.4-Estimated value of benefit ($)

32.5-Name of deceased #2

Name.

32.6-Date of death #2

dd/mm/yyyy

32.7-Executor name and address #2

Name/address.

32.08-Estimated value of benefit ($) #2

33-Sale,Transfer or Gift of Assets in the last 5 years*

NO go to Q34

YES please give details

Have you sold, transferred or given away any assets worth more than $1000 in the last 5 years? Provide a copy of the receipt or settlement statement

33.1-What did you sell, transfer or give away?

Description.

33.2-To whom was it sold, transferred or gifted?

Name.

33.3-Date transferred

dd/mm/yyyy

33.4-What was it worth?

33.5-How much was it sold for? ($)

33.6-How much did you receive net? ($)

33.7-What did you sell, transfer or give away? #2

Description.

33.8-To whom was it sold, transferred or gifted? #2

Name.

33.9-Date transferred #2

dd/mm/yyyy

33.10-What was it worth? #2

33.11-How much was it sold for? ($) #2

33.12-How much did you receive net? ($) #2

33.13-What did you sell, transfer or give away? #3

Description.

33.14-To whom was it sold, transferred or gifted? #3

Name.

33.15-Date transferred #3

dd/mm/yyyy

33.16-What was it worth? #3

33.17-How much was it sold for? ($) #3

33.18-How much did you receive net? ($) #3

34 Assets you own which are in somebody else's possession?*

NO go to Q35

YES please give details

Do you own any assets which are not currently in your possession?

34.1-Description of asset

Description.

34.2-What is it worth? ($)

34.3-Who has the asset? Name and address

Name/address.

34.4-Description of asset #2

Description.

34.5-What is it worth? ($) #2

34.6-Who has the asset? Name and address #2

Name/address.

35 Assets you contribute towards or helped purchase*

NO go to Q36

YES please give detail

Have you contributed or otherwise assisted in the purchase or improvement of any asset valued over $1000 which is held by someone else?

35.1-Description of asset

Description.

35.2-Who has the asset? Name and address

Name/address.

35.3-What is it worth? ($)

35.4-Description of asset

Description.

35.5-Who has the asset? Name and address #2

Name/address.

35.6-What is it worth? ($)

36-ASSETS/MONEY PAID TO CREDITORS.*

YES please give detail

As a result of pressure for payment from creditors have you, in the last 12 months, paid a total amount of more than $1000 over and above your normal repayments or surrendered any assets to a creditor?

36.1-Date paid/surrendered

dd/mm/yyyy

36.2-Type of asset (eg cash/house)

Name.

36.3-Value of asset ($)

36.4-Name of creditor

Name.

36.5-Date paid/surrendered #2

dd/mm/yyyy

36.6-Type of asset (eg cash/house) #2

Name.

36.7-Value of asset ($)

36.8-Name of creditor. #2

Name.

37-OTHER ITEM OF VALUE.-do you own any other assets or items of value? (eg jewellery, camera, artworks, antiques, copyrights)*

NO go to Q38

YES please give details

Other than your general household furniture,

37.1-Description of asset#1

Description.

37.5-Description of asset #2

Description.

37.9-Description of asset #3

Description.

37.13-Description of asset #4

Description.

37.17-Description of asset #5

Description.

37.2-Location of asset#1

Location.

37.6-Location of asset #2

Location.

37.10-Location of asset #3

Location.

37.14-Location of asset #4

Location.

37.18-Location of asset #5

Location.

Estimated resale value($)#1

Estimated resale value($)#2

Estimated resale value($)#3

Estimated resale value($)#4

Estimated resale value($)#5

37.4-Jointly owned.........#1

YES

37.8-Jointly owned..........#2

YES

37.12-Jointly owned .........#3

YES

37.16-Jointly owned ........#4

YES

37.20-Jointly owned #5

YES

37.21-Description of asset #6

Description.

37.24-Description of asset.#7

Name.

37.27-Description of asset.#8

Name.

37.22-Location of asset #6

Location.

37.24-Location of asset #7

Location.

37.28-Location of asset.#8

Location.

37.23-Estimated resale value ($) #6

Please attach a list if you have more assets

37.25-Estimated resale value ($) #7

37.29-Estimated resale value ($)#8

37.26-Jointly owned #6

YES

37.26-Jointly owned #7

YES

37.30- Jointly owned.#8

YES

38-SECURED CREDITORS-PART D--List your secured creditors. (Creditors who are not secured should be listed at Q40) 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

38.1-CREDITORS NAME No1

Name

38.2-SECURED CREDITORS- no. 1 ADDRESS

Creditor's postal address.

38.3-SECURED CREDITORS- no. 1- ACCOUNT/LOAN NUMBER

Account or loan number.

38.4-SECURED CREDITORS- no. 1- TOTAL AMOUNT OWING TO CREDITOR ($)

Total amount owing to this creditor ($).

38.5-SECURED CREDITORS-no.1-Type of security (eg mortgage)

Mortgage or personal loan.

38.6-SECURED CREDITORS- no.1 -DATE THE SECURITY WAS GIVEN

dd/mm/yyyy

38.7-SECURED CREDITORS- no.1 -DESCRIPTION OF SECURED ASSET.

Description.

38.8-SECURED CREDITORS- no.1 -LOCATION OF ASSET.

Location address.

38.9-SECURED CREDITORS- no.1 -ESTIMATED RESALE VALUE OF THE ASSET($)

$ this value should match the value stated in Q27 VEHICLES- Estimated resale value ($)

38.10-SECURED CREDITORS- no. 1 -IS IT A JOINT LOAN?

YES

38.11-SECURED CREDITORS- no. 1 - ARE THE PAYMENTS UP TO DATE?

YES

38.12-SECURED CREDITORS- no. 1-HAS THE CREDITOR REPOSSESSED THE ASSET?

YES

38.13-SECURED CREDITORS- no. 1-ARE YOU RELATED TO THE CREDITOR?

YES

Related creditors - If you are unsure whether a creditor is related, please refer to the information sheetaccompanying this form before answering this question. Related creditors must be disclosed by selecting Yes or No.

38.14-SECURED CREDITORS- no.2- NAME

Name of your creditor.List your secured creditors. (Creditors who are not secured should be listed at Q40)

38.15-SECURED CREDITORS- no. 2 ADDRESS

Postal address.

38.16-SECURED CREDITORS- no. 2- ACCOUNT/LOAN NUMBER

Account/loan number.

38.17-SECURED CREDITORS- no. 2- TOTAL AMOUNT OWING TO CREDITOR ($)

38.18-SECURED CREDITORS -no2-TYPE OF SECURITY (eg mortgage)

Mortgage or personal loan.

38.19-SECURED CREDITORS- no.2 -DATE THE SECURITY WAS GIVEN

dd/mm/yyyy

38.20-SECURED CREDITORS- no.2 -DESCRIPTION OF SECURED ASSET.

Description

38.21-SECURED CREDITORS- no.2 -LOCATION OF ASSET.

Location address.

38.22-SECURED CREDITORS- no.2 -ESTIMATED RESALE VALUE OF THE ASSET($)

38.24-SECURED CREDITORS- no. 2 -IS IT A JOINT LOAN?

YES

38.24-SECURED CREDITORS- no. 2 - ARE THE PAYMENTS UP TO DATE?

YES

38.25-SECURED CREDITORS- no. 2-HAS THE CREDITOR REPOSSESSED THE ASSET?

YES

38.26-SECURED CREDITORS- no. 2-ARE YOU RELATED TO THE CREDITOR?

YES

38.27-SECURED CREDITORS- no.3- NAME

Name of your creditor.List your secured creditors. (Creditors who are not secured should be listed at Q40)

38.28-SECURED CREDITORS- no. 3 ADDRESS

Postal address.

38.29-SECURED CREDITORS- no. 3- ACCOUNT/LOAN NUMBER

Account/Loan number.

38.30-SECURED CREDITORS- no. 3- TOTAL AMOUNT OWING TO CREDITOR ($)

38.31-SECURED CREDITORS-no3-TYPE OF SECURITY (eg mortgage, personal loan)

Mortgage , loan.

38.32-SECURED CREDITORS- no.3 -DATE THE SECURITY WAS GIVEN

dd/mm/yyyy

38.33-SECURED CREDITORS- no.3 -DESCRIPTION OF SECURED ASSET.

Description.

38.34-SECURED CREDITORS- no.3 -LOCATION OF ASSET.

Location address.

38.35-SECURED CREDITORS- no.3 -ESTIMATED RESALE VALUE OF THE ASSET($)

38.36-SECURED CREDITORS- no. 3 -IS IT A JOINT LOAN?

YES

38.37-SECURED CREDITORS- no. 3 - ARE THE PAYMENTS UP TO DATE?

YES

38.38-SECURED CREDITORS- no. 3-HAS THE CREDITOR REPOSSESSED THE ASSET?

YES

38.39-SECURED CREDITORS- no. 3-ARE YOU RELATED TO THE CREDITOR?

YES

39 EQUITY LOAN Have you used any equity or made additional loans withdrawals against any of the secured property in the last 12 months?*

NO go to Q40

YES please give details

Have you used any equity or made any additional loan withdrawals againstany of the above secured property in the last 12 months?

39.1-Date

dd/mm/yyyy

39.2-Amount withdrawn ($)

Amount

40 UNSECURED CREDITORS- An unsecured creditor is a creditor who does not hold security over any particular asset you own. They can include credit cards, unpaid bills, loans from friends and relatives, personal guarantees and contingent debts. List all debts that have not already been listed as secured at Q38. Related creditors If you are unsure whether a creditor is related, please refer to the instructions for completing these forms in the front of this booklet before answering this question. Related creditors must be disclosed by ticking the yes or no box. Joint debts: if the debt is owed jointly with another person you must disclose this by indicating Yes or No.TAX debts if you owe a debt to the Australian Taxation Office, when listing your debt below DO NOT enter your TAX FILE NUMBER (TFN) in the account number column.

If you have more than 10 creditors please email us as we will need to add a supplementary sheet.

40.1-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.2-Nature of debt

Loan, Credit card, ect

40.3-Account number

Account number.

40.4-Mth/Yr incurred

mm/yyyy

40.5-Total amount owing ($)

40.6-Related party?

YES

40.7-Joint debt?

YES

40.8-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.9-Nature of debt

Credit card, loan ect.

40.10-Account number

Account number.

40.11-Mth/Year incurred

mm/yyyy

40.12-Total amount owing ($)

Dollar value owed.

40.13-Related party?

YES

40.14-Joint debt?

YES

40.15-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.16-Nature of debt

Loan, Card

40.17-Account number

Account number.

40.18-Mth/Yr incurred

mm/yyyy

40.19-Total amount owing ($)

40.20-Related party?

YES

Related to you.

40.21-Joint debt?

YES

40.22-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.23-Nature of debt

Credit Card, personal loan.

40.24-Account number

Account number.

40.25-Mth/Yr incurred

mm/yyyy

40.26-Total amount owing ($)

40.27-Related party?

YES

Related to you?

40.28-Joint debt?

YES

40.29-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.30-Nature of debt

Credit card, loan ect

40.31-Account number

Account number.

40.32-Mth/Year incurred

mm/yyyy

40.33-Total amount owing ($)

40.34-Related party?

YES

Are you related.

40.35-Joint debt?

YES

40.36-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.37-Nature of debt

Credit card, loan ect.

40.38-Account number

Account Number.

40.39-Mth/Year incurred

mm/yyyy

40.40-Total amount owing ($)

40.41-Related party?

YES

Related to you.

40.42-Joint debt?

YES

40.43-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.44-Nature of debt

Credit card, loan, ect

40.45-Account number

Account number.

40.46-Mth/Year incurred

mm/yyyy

40.47-Total amount owing ($)

40.48-Related party?

YES

Related to you.

40.49-Joint debt?

YES

40.50-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.51-Nature of debt

Credit card, loan, ect

40.52-Account number

Account number.

40.53-Mth/Year incurred

mm/yyyy

40.54-Total amount owing ($)

40.55-Related party?

YES

Are you related.

40.56-Joint debt?

YES

40.57-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.58-Nature of debt

Credit card, loan, ect.

40.59-Account number

Account number .

40.60-Mth/Year incurred

mm/yyyy:

40.61-Total amount owing ($)

40.62-Related party?

YES

Are you related.

40.63-Joint debt?

YES

40.64-Creditor name and address

Bank or person you owe money to.Creditors name and address.

40.65-Nature of debt

Credit card, loan, ect.

40.66-Account number

Account number .

40.67-Mth/Year incurred

mm/yyyy.

40.68-Total amount owing ($)

40.69-Related party?

YES

Are you relate.

40.70-Joint debt?

YES

40.71-TOTAL AMOUNT OWING.

Note: certain creditors can continue recovery action during bankruptcy and you may not be released from debts suchas child support, maintenance and debts incurred by fraud.

41 SOLE TRADER OR PARTNERSHIP -Have you been in business as a sole trader or in partnership at any time in the last 5 years?

NO Go to Q43

YES please give details

Have you been in business as a sole trader or in partnership at any time in the last 5 years.

41.1-Business name

Name.

41.2-Business address

Address of business.

41.3- Is the business registered with the Australian Taxation Office for GST payments?

YES

41.4- Is the GST registration on a cash or accrual basis?

CASH

ACCRUAL

41.5- Do you have an Australian Business Number (ABN)

YES

Number below

41.6-ABN

Number

41.7-What is the nature of this business?

Name.

41.8-Partner’s name and address (if any)?

Name.

41.9-Second partner’s name and address (if any)?

Name/Address.

41.10-Is there a written partnership agreement?

YES attach copy

Copy will be sent as supporting documentation.

41.11-When did the business start operating?

dd/mm/yyyy

41.12-Has the business ceased operating?

YES provide date ceased

41.13-Dated ceased

dd/mm/yyyy

41.14-Have you sold any business assets or have you sold the business as a going concern in the past 2 years?

YES please give details

Add detail below.

41.15-Business name/asset description

Names

41.16-Date sold

dd/mm/yyyy

41.17-Name of purchaser

Name.

41.18-Amt received ($)

41.19-Business name/asset description

Names

41.20-Date sold

dd/mm/yyyy

41.21-Name of purchaser

Name.

41.22-Amt received ($)

41.23-Business name/asset description

Names.

41.24-Date sold

dd/mm/yyyy

41.25-Name of purchaser

Name.

41.26-Amt received ($)

41.27-Are there any other business assets not sold?

YES please give details

41.28-STOCK-Resale value ($)

41.29-Stock Location of assets

Address where asset is located.

41.30-PLANT and EQUIPMENT-Resale value ($)

41.31-PLANT Location of assets

Address where the asset is located.

41.32-FIXTURES and FITTINGS-Resale value ($)

41.33-FIXTURES/FITTINGS Location of assets

Address where the asset is located.

41.34-LICENCES-Resale value ($)

41.35-LICENCES Location of assets

Address where the asset is located.

41.36-BANK ACCOUNTS-Resale value ($)

41.37-BANK ACCOUNT Location of assets

Address where the asset is located.

41.38-BOOK DEBT Resale value ($)

41.39-BOOK DEBT Location of assets

Location.

41.40-OTHER(please describe 41.41) below Resale value

41.41-OTHER Location of assets

Address

41.42-OTHER DESCRIPTION.

Discription.

41.42-Did your business cease operating more than 6 months ago?

NO -you must answer Q42 before moving on to Q43

YES- go to Q43

42A SOLE TRADER AND PARTNERSHIP-Operating or Ceased in past 6 months.

YES

Is any stock on consignment or subject to retention of title?

42B Is there a bill of sale or other security over business assets?

YES attach copy of the bill of sale

42C-Do you have a lease agreement over your business premises?

YES please give details below

Landlord name.

Name

Landlord address.

Name.

Period of lease.

From.

Lease end.

End date.

42D-Have you sold or tried to sell the business?

YES please give details

Agents name

Name.

Agents address

Name

Asking price($)

42E Who has your business records? -Name

Name

Telephone number

Number.

Address

Address.

42F-Who prepares your financial statements and tax returns?-NAME

Name

Telephone number

Number including area code if land line

Address

Attach copies of the last avaliable statements

43A COMPANIES-Have you been a director or had a management role in a company at any time in the last 5 years?

NO -Go to Q44

YES please give details

If you have operated more than one company please copy this section, complete and attach.

Company name

Name.

ABN

Number.

Registered address

Address.

Trading name

Name.

Nature of company activity

Name.

Is this a trustee company? If yes, what is the name of the trust?

Name of trust.

Officeholder position held by you in the last 2 years

Director

Secretary

If DIRECTOR Date resigned

date resigned

If SECRETARY Date resigned

date resigned

43B Has a liquidator, receiver or administrator been appointed to manage the company?

YES please give details

Liquidator Name

Name.

Liquidators Address

Address.

43C Is a dividend or distribution expected?

YES please give details

43D Does the company owe you any wages, loans or any other money?

YES please give details

Description what company owe you any wages, loans or any other money?

Description.

Amount owed ($)

Description what company owe you any wages, loans or any other money?

Description.

Amount owed ($)

43E Do you own, or have you at any time during the last 5 years owned any shares in this company?

YES please give details

No. of shares

Number.

Date sold shares in this company.

dd/mm/yyyy

Transferee name and address

Name/Address.

Sale proceeds ($)

Number of shares.

Number.

Date sold

dd/mm/yyyy

Transferee name and address

Name/Address.

Sale proceeds ($)

43F Have you transferred any assets to the company in the last 5 years?

YES please give details

Description of asset

Description.

Date of transfer

dd/mm/yyyy

Value of asset ($)

Money you received ($)

Description of asset

Description.

Date of transfer

dd/mm/yyyy

Value of asset ($)

Money you received ($)

43G Who prepares your financial statements and tax returns?-NAME

Name of person/company.

Telephone number

Number.

Address

Attach a copy of the last available statements this will be a seperate document.

44 TRUSTS Have you been a unit holder in or beneficiary of a trust in the last 5 years OR Have you transferred any assets to a trust in the last 5 years?

YES please give details

If you have been involved in more than one trust please copy this section, complete and attach.

Trust name

Name.

Principal activity

Name.

Type of trust

UNIT

DISCRETIONARY

OTHER

Trustee name

Name.

Trustee address

Address.

44C Are there any assets owned by the trust?

YES please give details below

Asset description

Description.

Resale value ($)

Asset description

Description.

Resale value ($)

Asset description

Description.

Resale value ($)

44D Does the trust owe you any wages, loans or other money?

YES please give details below

Description

Description.

Amount owed ($)

Description

Description.

Amount owed ($)

44E Have you received any income or capital distribution from this trust in the last 2 years?

YES please give details

How often do you receive a distribution

Number.

Date of last payment

dd/mm/yyyy

Amount of last payment ($)

How often do you receive a distribution

Number.

Date of last payment

dd/mm/yyyy

Amount of last payment ($)

44F Have you transferred any assets to the trust in the last 5 years?

YES please give details below

Description of asset

Description.

Date of transfer

dd/mm/yyyy

Value of asset ($)

Money you received ($)

Description of asset

Description.

Date of transfer

dd/mm/yyyy

Value of asset ($)

Money you received ($)

Description of asset

Description.

Date of transfer

dd/mm/yyyy

Value of asset ($)

Money you received ($)

44G Name and address of the person holding the trust deed, books of account and financial statements- NAME

Name.

Telephone number

Number.

Address

Address.

Email Address

Attach a copy of the last available financial statements

DECLARATION- Note: S267(2) of the Bankruptcy Act provides that a person must not make a declaration that the person knows to be false. Penalty: Imprisonment for 12 months. I declare that the particulars set out in this statement are correct. YOUR Signature

Bankrupters Signature.

Date (DD/MM/YYYY)

Date

If you received assistance completing this form, the person providing the assistance should sign the statement below. I declare that before this form was completed, I carefully read to/interpreted for the person named above the that prescribed information and the questions on this form or [where the person is physically incapacitated] satisfied myself that the person had read and understood the information and questions. The responses provided in this form are those of the person named above.

Reason the debtor required your assistance

Full name and address of the person assisting

Name/Address.

Signature of the person assisting

Assisting person signature.

Date (DD/MM/YYYY)

dd/mm/yyyy

PRIVACY

IF THE SITUATION BELOW APPLIES TO YOU NEED TO PROVIDE THE DOCUMENTS TO SUPPORT YOUR APPLICATION:

QUESTION 5- Child Support Child Support Agreement/Assessment Notice.QUESTION 6-Family law financial proceeding-Family law or spousal order or application.QUESTION 7- Legal actions-Summons, writ or other documents.QUESTION 8-Proceeds of crime-Court order or application.QUESTION 9- Pay slip/Tax Assessment Notice/Centrelink Statements.******DOCUMENTS IN SUPPORT OF INCOME PLEASE ENSURE TAX FILE NUMBERS CANNOT BE DISPLAYED BY ERASING OR "BLACKOUT" SO THE TFN IS NOT VISIBLE.QUESTION 32- Deceased estate-Copy of willQUESTION 33- Sale, Transfer or gift of assets-Property settlement statements.QUESTION 41D-Sole trader/partnership-Partnership Agreement.QUESTION 42B-Security over business assets-Bill of sale or other security documents/agreements.QUESTION 42F- Sole trader/partnership-Last available financial statements.QUESTION 43G- Companies-Last available financial statements.QUESTION 44G- Trusts-Last available financial statements.

AS PART OF YOUR BANKRUPTCY-YOU ARE REQUIRED TO PROVIDE SUPPORTING DOCUMENTATION

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Online interface allows you to enter the relevant details and fills out the AFSA form that can be printed out reviewed and signed.

Online Bankruptcy Form

The interface below once completed will fill both forms Debtors Partition and Statement of Affairs required to become bankrupt in PDF document and we will send it to you.

Not every question will be relevant to your personal situation.

Where a question is required and not answered the interface will redirect you to the question and it must be answered.

Or you can call us and we can advise what needs to be done.

If its overwhelming and stressful we can lodge the complex paperwork for you (80 pages) however we will apply an administration fee.

Don’t waist your money and time, get a fresh start, what are you waiting for!!

DEBTOR’S PETITION (APPLICATION TO BECOME BANKRUPT) Bankruptcy Act 1966 Section 55(2) The information you add is part of the official information the AFSA requires.

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Online Bankruptcy Form

The interface below once completed will fill both forms Debtors Partition and Statement of Affairs required to become bankrupt in PDF document and we will send it to you.

Not every question will be relevant to your personal situation.

Where a question is required and not answered the interface will redirect you to the question and it must be answered.

Or you can call us and we can advise what needs to be done.

If its overwhelming and stressful we can lodge the complex paperwork for you (80 pages) however we will apply an administration fee.

Don’t waist your money and time, get a fresh start, what are you waiting for!!

DEBTOR’S PETITION (APPLICATION TO BECOME BANKRUPT) Bankruptcy Act 1966 Section 55(2) The information you add is part of the official information the AFSA requires.

Uploading Files. Please Wait.

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