TDA BLANK NOTES Date Lodged Administration Number Surname Title Mr/Mrs/Ms Given Name/s Person proposing termination Debtor/Creditor Name Postcode Contact Number Postal Address Email Address Contact Person Report from Debt Agreement Administrator Please complete from a current administrator status report. Date of administrator status report (not more than two months old and not a three month arrears default report) Date of Administrator status report Date of debtor’s last payment to administrator Total arrears Realisations charge paid to Australian Government Fees paid to administer debt agreement Allowable expenses paid to third party Total dividends paid to creditors Balance on hand with administrator Total payments plus balance Total receipts from debtor Total receipts from sale of asset Total receipts If the proposal involved sale of property, has the property been sold? YES NO NO NOT APPLICABLE NOT APPLICABLE If no, please provide details Has the debtor made arrangements to catch up arrears? YES YES NO NO NOT APPLICABLE NOT APPLICABLE If yes, please provide details Debtor/Creditor/Authorised Officer of Creditor I understand that where a debt agreement is terminated: • the debts are reinstated after taking into account payments made under the debt agreement; and • the debtor no longer has protection under the Bankruptcy Act and creditors are entitled to take action to recover their debt. Name (please print) Position (if creditor) Signature DATE SIGNED Return to Australian Financial Security Authority PO Box 10443 Adelaide Street Brisbane Queensland 4000 Phone 1300 364 785 Fax 07 3360 5494 Email debtagreementservice@afsa.gov.au Explanatory Statement Please indicate the reason for proposing this termination and provide information creditors should know. Debtor has ceased payments and is unlikely to recommence Significant undisclosed unsecured debts Significant understatement of unsecured debts Significant undisclosed income or assets Yes Unemployment/Redundancy Yes Loss of income Yes Unexpected medical expenses Yes Loss of supporting payments eg. free board Yes Increase in number of dependants Relationships breakdown and separation Yes Incurred significant post debt agreement debts Yes Other: Yes please specify Supporting statement Other information creditors need to know) Changes in creditor name or address since debt agreement commenced Creditor name on debt agreement proposal Creditor name on debt agreement proposal 1 Nature of debt 1 REFERENCE NUMBER 1 CURRENT CREDITOR NAME untitled70 1 Current Creditor Postal Address / Email Address untitled75 2 Creditor name on debt agreement proposal untitled61 2 REFERENCE NUMBER untitled66 2 CURRENT CREDITOR NAME untitled71 2 Current Creditor Postal Address / Email Address untitled76 3 Creditor name on debt agreement proposal untitled62 3 REFERENCE NUMBER untitled67 3 CURRENT CREDITOR NAME untitled72 3 Current Creditor Postal Address / Email Address untitled77 4 Creditor name on debt agreement proposal untitled63 4 REFERENCE NUMBER untitled68 4 CURRENT CREDITOR NAME untitled73 4 Current Creditor Postal Address / Email Address untitled78 5 Creditor name on debt agreement proposal untitled64 5 REFERENCE NUMBER untitled69 5 CURRENT CREDITOR NAME untitled74 5 Current Creditor Postal Address / Email Address untitled79 Debtor/Creditor/Authorised Officer of Creditor I declare that the particulars set out in this statement are correct. Offence: Section 267 of the Bankruptcy Act provides that a person must not sign a declaration that the person knows to be false. Penalty:Imprisonment for 12 months Signature Name (please print) Position (if creditor) Date signed Share this:TwitterFacebookLike this:Like Loading...