Form 72C Statement of Financial Position (Word 248KB)



MAGISTRATES' COURT GENERAL CIVIL PROCEDURE RULES 2020Rule 72.02(4), 72.04(3), 72.05(5)(a) FORM 72CJUDGMENT DEBTOR’S STATEMENT OF FINANCIAL POSITIONIN THE MAGISTRATES' COURTCourt Number FORMTEXT ?????OF VICTORIA AT FORMTEXT ????? FORMTEXT ?????Judgment creditorOf: (address) FORMTEXT ?????and FORMTEXT ?????Judgment debtorOf: (address) FORMTEXT ?????Date of Document FORMTEXT ?????Filed on behalf of: FORMTEXT ?????Australian lawyer name: FORMTEXT ?????Code: FORMTEXT ?????Address: FORMTEXT ?????Telephone: FORMTEXT ?????Reference FORMTEXT ?????To FORMTEXT ?????(judgment debtor)of FORMTEXT ?????(address)TAKE NOTICE: Complete this form by giving the information requested below. The completed forms signed by you must be sent to (judgment creditor)at (address) FORMTEXT ?????before (day of hearing named in the summons) FORMTEXT ?????If you do not do this, the Court may make an order that you attend before the Court and give the information.Dated: FORMTEXT ?????(Signed by judgment creditor or Australian lawyer )1.AMOUNT AND SOURCE OF WEEKLY INCOMEOccupation FORMTEXT ?????If working for an employer:Name of Employer FORMTEXT ?????Address of Employer FORMTEXT ?????Gross Wage$ FORMTEXT ?????Current overtime (if any)$ FORMTEXT ?????Car and other allowances and commissions$ FORMTEXT ?????If self-employed or in partnershipAverage pre-tax earnings for last 12 months$ FORMTEXT ?????If unemployedState length of last employment FORMTEXT ?????Date when last employment ceased FORMTEXT ?????/ FORMTEXT ?????/ FORMTEXT ?????Gross weekly amount earned$ FORMTEXT ?????Pension or other benefit received$ FORMTEXT ?????Workers’ compensation received$ FORMTEXT ?????Other monies$ FORMTEXT ?????Maintenance received$ FORMTEXT ?????Superannuation received$ FORMTEXT ?????Board or rent received$ FORMTEXT ?????Average weekly income including any interest from banks and building societies, and [any income from] investment in shares, etc:$ FORMTEXT ?????Average weekly dividend on shares FORMTEXT ?????Other income ( give details)$ FORMTEXT ????? FORMTEXT ?????TOTAL GROSS WEEKLY INCOME$ FORMTEXT ?????2.PROPERTY AND ASSETSLand, including vacant land – For each piece of land:Market valueAmount of mortgageNet value(1)$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????(2)$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????(3)$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????Motor vehicle(s) - For each motor vehicleVehicle 1Vehicle 2Vehicle 3Year FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Make FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Model FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Market Value$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????Amount owing to finance company$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????Net Value$ FORMTEXT ?????$ FORMTEXT ?????$ FORMTEXT ?????Deposit in banks, buildings societies, etc.$ FORMTEXT ?????Cash presently in your possession$ FORMTEXT ?????Value of other investments including shares, debentures, bonds$ FORMTEXT ?????Money owing to you From FORMTEXT ?????$ FORMTEXT ????? From FORMTEXT ?????$ FORMTEXT ?????Total$ FORMTEXT ?????Value of interest in partnership or business $ FORMTEXT ?????Furniture, household and personal goodsMarket Value$ FORMTEXT ?????Amount owing to finance company$ FORMTEXT ?????Net value$ FORMTEXT ?????Life insurance policies – Give particulars and surrender value of each policy FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ????? FORMTEXT ?????$ FORMTEXT ?????Other assets (give particulars)$ FORMTEXT ????? FORMTEXT ?????TOTAL PROPERTY AND ASSETS$ FORMTEXT ?????3.DEBTS, LIABILITIES AND OTHER FINANCIAL OBLIGATIONS(a)Weekly expensesIncome tax$ FORMTEXT ?????Superannuation$ FORMTEXT ?????Housing (mortgage, board, rent, hospital or institution)$ FORMTEXT ?????Municipal Rates$ FORMTEXT ?????Water and sewerage rates$ FORMTEXT ?????Land tax$ FORMTEXT ?????Child care costs incurred for the purpose of earning income$ FORMTEXT ?????Maintenance actually paid$ FORMTEXT ?????Instalment payments such as for household goods or tools of trade To FORMTEXT ?????$ FORMTEXT ????? To FORMTEXT ?????$ FORMTEXT ????? To FORMTEXT ?????$ FORMTEXT ?????Total$ FORMTEXT ?????Electricity and Gas$ FORMTEXT ?????Food$ FORMTEXT ?????Other general household expenses$ FORMTEXT ?????Motor vehicle expenses (registration, insurance, maintenance, fuel)$ FORMTEXT ?????Fares$ FORMTEXT ?????Telephone$ FORMTEXT ?????Insurance policy premiums$ FORMTEXT ?????School fees and other school expenses$ FORMTEXT ?????Clothing and shoes$ FORMTEXT ?????Medical and chemist expenses$ FORMTEXT ?????Entertainment$ FORMTEXT ?????Payments on court orders and fines$ FORMTEXT ?????Other expenses (give details)$ FORMTEXT ????? FORMTEXT ?????Total weekly expenses$ FORMTEXT ?????(b)Other debts outstandingGive particulars of debts under hire purchase, leasing, credit card or other credit contracts, department store accounts, guarantee or personal loan: To FORMTEXT ?????due on FORMTEXT ?????$ FORMTEXT ????? To FORMTEXT ?????due on FORMTEXT ?????$ FORMTEXT ????? To FORMTEXT ?????due on FORMTEXT ?????$ FORMTEXT ?????Total$ FORMTEXT ?????4.If any of the assets referred to in paragraph 2 above is owned jointly, identify each asset and give the name of the other owner or owners: FORMTEXT ?????5.If any of the debts referred to in paragraph 3 is due jointly, identify each debt and give the name of the other debtor or debtors: FORMTEXT ?????6.Give particulars of any other circumstances which affect the financial situation of the judgment debtor such as the number and age of dependants, marital status and health: FORMTEXT ?????Date FORMTEXT ?????Signature of judgment debtor ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download