Rule 10.47
1. Title of the debtor.
2. Debtor’s identification details.
3. Any previous name or other names by which the debtor is known or has been known during the last five years immediately before the date of the bankruptcy application.
4. Any previous address at which the debtor has resided at during the three years immediately before the date of the bankruptcy application.
5. Name and address for each creditor.
6. Amount each creditor claims is due.
7. Debtor’s occupation (if any).
8. Debtor’s employment status.
9. Where the debtor is, or has been, self-employed other than as a partner in a partnership, during the three years preceding the date of the bankruptcy application, in respect of each business—
(a)name and trading address of the business;
(b)name or names, other than the debtor’s name, in which the debtor carried on business;
(c)nature of the business;
(d)trading address or addresses of the business and any address or addresses at which the debtor has carried on business during the period in which any of the debtor’s bankruptcy debts were incurred; and
(e)where the business has ceased trading, the date when the business ceased trading.
10. Total value of assets.
11. Total value of liabilities.
12. Where in the five years preceding the date of the bankruptcy application the debtor has given away, placed into a trust for the benefit of any person, given a preference within the meaning of section 340 of the Act, has rights or excluded rights under section 342A of the Act or has transferred or sold for less than its true value any assets that the debtor owned, either alone or jointly, including the surrender of life, endowment and pension policies in relation to each asset—
(a)description of the asset;
(b)date the debtor gave away, transferred or sold the asset;
(c)relationship of that person to the debtor;
(d)estimated market value or true value of the asset at the date of the bankruptcy application;
(e)value at which the asset was given away, transferred or sold; and
(f)net proceeds (if any) (less any charges and legal fees).
13. Where any asset is owned jointly with another person, the nature of the asset.
14. Where any asset is subject to the rights of any person (other than a joint owner), whether as a secured creditor of the debtor or otherwise, in respect of each asset, the nature of third party rights.
15. Where the debtor owns a motor vehicle or has disposed of any vehicle during the 12 months immediately preceding the date of the bankruptcy application, in respect of each motor vehicle—
(a)make, model and year of manufacture;
(b)what the motor vehicle is used for by the debtor;
(c)save where the motor vehicle has been disposed of, the location of the motor vehicle;
(d)where the motor vehicle has been disposed of, the date of disposal and any proceeds from that disposal.
16. Where the debtor regularly uses a motor vehicle that the debtor does not own, in relation of each motor vehicle—
(a)make and model; and
(b)debtor’s relationship to the vehicle’s owner.
17. Where the debtor owns or has an interest in any property, in relation to each property—
(a)address;
(b)type of and description of the property;
(c)nature of the interest
(d)value of that interest; and
(e)any income received by the debtor from the property.
18. Where the debtor holds or has held within the five years immediately before the date of the bankruptcy application any occupational pension, personal pension, endowment or other life policy in relation to each policy—
(a)type of policy;
(b)approximate date when the policy was taken out; and
(c)estimated value of policy.
19. Debtor’s net monthly income from all sources.
20. Debtor’s monthly surplus income after taking into account any contribution made by a member of the debtor’s family to the amount necessary for the reasonable domestic needs of the debtor and the debtor’s family.
21. Current (or last) income tax reference number.
22. In relation to each creditor—
(a)name and address;
(b)date the debt was incurred;
(c)the amount the creditor claims the debtor owes the creditor;
(d)where the debt is secured, the property of the debtor which is claimed by the creditor to clear of reduce the creditor’s debt.