PROOF
OF IDENTITY
BY POST
APPLIcATION
FOR ISSUE
OF A BANkRUPTcY NOTIcE
Bankruptcy
Act Proof
1966ofSubsection
41(2)
To
complete you
Identity by post
please send copies of your identity documents and this form to:
Bankruptcy Regulations 1996 Regulation 4.02
Australian Financial Security Authority
Locked Bag 7720
Canberra Business Centre ACT 2610
1. YOUR CONTACT DETAILS
Name
DOFull
NOT
SEND ORIGINAL DOCUMENTS
Title
First Name
Middle name/s
Any original documents received will be returned immediately. They will not be copied or used to verify your identity. The protection
of your original documents is your responsibility. We do not take any responsibility for the loss and/or damage of your original
documents if you choose to post them to us against our advice.
Surname
Please complete the form details below.
Address
Address
Line
1 your Online Services username)
Username
(enter
Address Line 2
Title
Suburb
First name
Middle name/s
State
Postcode
Telephone Number
Surname
-
-
Email Address
Telephone number
-
-
I have obtained a final judgment/order against the person to whom the Bankruptcy Notice
Email address (email address should be the same address used in Online Services)
is to be issued. (You must attach the final judgment/order to the draft Bankruptcy Notices.)
The final judgment/ order was obtained within the last six years. (A Bankruptcy Notice cannot be
issued
if the judgment/
Submission
type order upon which it is based is more than 6 years old).
Is this a new submission or are you providing additional information?
The
final judgment/ order has NOT been stayed. (A Bankruptcy Notice cannot be issued if the
operation of the judgment/ order has been stayed.)
New submission
Additional information
I have converted the judgment/ order amount (which was expressed in foreign currency)
Primary Identity Documents
to Australian dollars. (Where a judgment/ order is expressed in a foreign currency, you must convert this
select
theatidentity
document/s
yourate
areprevailing
submitting.
toPlease
Australian
dollars
the telegraphic
transfer
as at 2 working days prior to applying for this
Bankruptcy Notice.)
Australian passport (70 points)
Australian citizenship certificate (70 points)
No
Yes
No
Yes
No
Yes
or
Not Applicable
Change of name certificate (40 points)
I have attached supporting documentation for my claim for legal costs in addition to the
Australian
birth
certificate
(70 points)
Australian marriage certificate (40 points)
judgment/
order
amount.
(If you are claiming costs, a certificate of the taxed or assessed costs must be
attached to the draft Bankruptcy Notices.)
Yes
Australian driver’s licence (40 points)
I have
attached an interest schedule to support my claim
for interest after the date of the
Australian visa (70 points)
Medicare card (20 points)
judgment/ order. (If interest is being claimed, details for the calculation of the amount of interest claimed
must be set out in the interest schedule to be attached to the draft Bankruptcy Notices.)
or
Yes
Not Applicable
or
Yes
Not Applicable
Secondary Identity Documents
If you are submitting documents from the secondary list of identity documents please enter the document titles here
separated of
byApplicant
a comma e.g. bank card, proof of age card.
Signature
Date
D D M M Y Y Y Y
Check this box if you are a solicitor or agent of the creditor
BNAPP-0812
PAYREF123456
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APPLIcATION FOR ISSUE OF A BANkRUPTcY NOTIcE
Bankruptcy
1966 Subsection 41(2)
ChangeAct
of Name
Are yourRegulations
documents under
same name
as your Online Services account?
Bankruptcy
1996the
Regulation
4.02
Yes
No
DETAILS
If1.no,YOUR
please CONTACT
enter the reason
for your change of name e.g. marriage, legal name change, etc.
Full Name
Title
First Name
Middle name/s
Surname
Address
Additional Information:
Address
Line 1
Please enter any additional information/comments in the space provided below.
Address Line 2
Suburb
State
Postcode
Telephone Number
-
-
Email Address
I have obtained a final judgment/order against the person to whom the Bankruptcy Notice
is to be issued. (You must attach the final judgment/order to the draft Bankruptcy Notices.)
Yes
No
Yes
No
Yes
No
I have converted the judgment/ order amount (which was expressed in foreign currency)
to Australian dollars. (Where a judgment/ order is expressed in a foreign currency, you must convert this
Yes
or
I have attached supporting documentation for my claim for legal costs in addition to the
judgment/ order amount. (If you are claiming costs, a certificate of the taxed or assessed costs must be
Yes
attached to the draft Bankruptcy Notices.)
Not Applicable
I have attached an interest schedule to support my claim for interest after the date of the
judgment/ order. (If interest is being claimed, details for the calculation of the amount of interest claimed
Yes
The final judgment/ order was obtained within the last six years. (A Bankruptcy Notice cannot be
issued if the judgment/ order upon which it is based is more than 6 years old).
The final judgment/ order has NOT been stayed. (A Bankruptcy Notice cannot be issued if the
operation of the judgment/ order has been stayed.)
to Australian dollars at the telegraphic transfer rate prevailing as at 2 working days prior to applying for this
Bankruptcy Notice.)
must be set out in the interest schedule to be attached to the draft Bankruptcy Notices.)
Not Applicable
or
or
Not Applicable
Signature of Applicant
Date
D D M M Y Y Y Y
Check this box if you are a solicitor or agent of the creditor
BNAPP-0812
PAYREF123456
Page 1 of 6
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