Form 28B - Statement of Affairs by an Individual - Community Law
Form 28B - Statement of Affairs by an Individual - Community Law
Form 28B - Statement of Affairs by an Individual - Community Law
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5. Debts <strong>an</strong>d Liabilities (give details)Municipal rates.Water <strong>an</strong>d sewerage rates.L<strong>an</strong>d tax.Child care costs (kindergarten, day care,etc.).Mainten<strong>an</strong>ce actually paid.Instalment payments (state purpose).Electricity.Gas.Telephone.Food.Other general household expenses.Car expenses (registration, insur<strong>an</strong>ce,mainten<strong>an</strong>ce, fuel).Fares.Insur<strong>an</strong>ce policies.School fees <strong>an</strong>d other schooling costs.Hire purchase, leases, credit cards, creditcontracts, personal lo<strong>an</strong>s, store accounts,guar<strong>an</strong>tees being paid <strong>of</strong>f, etc.)Total amount due.To:Total amount due.To:Total amount due.To:TOTAL OTHER DEBTS:6. Have <strong>an</strong>y <strong>of</strong> the above debts been jointlyincurred with <strong>an</strong>y other person? Givedetails.7. Give details <strong>of</strong> <strong>an</strong>y other circumst<strong>an</strong>ceswhich affect your fin<strong>an</strong>cial position (e.g.number <strong>an</strong>d age <strong>of</strong> dependents, maritalstatus, health, etc.).Date: _____/_____/_____________________________________SignatureWARNINGAN INSTALMENT ORDER THAT IS MADE AS A RESULT OF A FALSESTATEMENT MAY BE VARIED OR CANCELLED
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