Form 28B - Statement of Affairs by an Individual - Community Law

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Average weekly income frominvestments in banks, buildingsocieties, shares, etc.Other (e.g. Family Allowance – givedetails).TOTAL GROSS WEEKLY INCOME:2. WEEKLY EXPENSESIncome tax.Superannuation.Health insurance.Union fees.Housing (mortgage, board, rent).Clothing and shoes.Medical and chemist expenses.Entertainment.Payments on Court orders and fines.Other expenses (give details).TOTAL WEEKLY EXPENSES:3. Are there any persons who contribute topaying your expenses? If so, who arethey and how much do they contribute?4.PROPERTY AND ASSETSMarket value of house (place of residence)owned.Amount owing on mortgage.
Net value of interest on house.Market value of any other house or land.Amount owing on mortgage.Net value or interest in other house orland owned.Market value of motor vehicle(s).(a) YearMake/model.(b) YearMake/model.Amounts owing under finance on motorvehicles.Net value of interest(s) on motor vehicles.Cash in banks, building societies, etc.Cash on hand.Value of other investments includingshares, debentures, bonds.Money owed to you.Value of interest in partnership orbusiness (including stock, goodwillequipment, debtors).State approximate re-sale value offurniture and personal goods.Net value of interest.Other assets (give details)TOTAL NET VALUE:Life insurance policies (specify insurer,policy number, surrender value(s)).TOTAL PROPERTY AND ASSETS:Are any assets jointly owned?details.Give
Page 1: Denise Reed (Chair)Dept. of Geology

Form 28B - Statement of Affairs by an Individual - Community Law

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