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TDA







    Person proposing termination







    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)













    YES


    NO


    NOT APPLICABLE

    If no, please provide details

    Has the debtor made arrangements to catch up arrears?

    YES


    NO


    NOT APPLICABLE


    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.





    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.





    Yes


    Yes


    Yes


    Yes


    Yes



    Yes


    Yes


    Yes






    Supporting statement








    Changes in creditor name or address since debt agreement commenced
    Creditor name on debt agreement proposal

    Creditor name on debt agreement proposal


    Nature of debt


    1 CURRENT CREDITOR NAME


    1 Current Creditor Postal Address / Email Address

    2 Creditor name on debt agreement proposal


    2 REFERENCE NUMBER


    2 CURRENT CREDITOR NAME


    2 Current Creditor Postal Address / Email Address

    3 Creditor name on debt agreement proposal


    3 REFERENCE NUMBER


    3 CURRENT CREDITOR NAME


    3 Current Creditor Postal Address / Email Address

    4 Creditor name on debt agreement proposal


    4 REFERENCE NUMBER


    4 CURRENT CREDITOR NAME


    4 Current Creditor Postal Address / Email Address

    5 Creditor name on debt agreement proposal

    5 REFERENCE NUMBER


    5 CURRENT CREDITOR NAME


    5 Current Creditor Postal Address / Email Address

    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





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