Examination notice - individual51 http://www.ucprforms.lawlink.nsw.gov.au/ucprforms/index.html

Form 51 (version 3)
UCPR 38.1

EXAMINATION NOTICE – INDIVIDUAL

COURT DETAILS
Court
#Division
#List
Registry
Case number
TITLE OF PROCEEDINGS
[First] plaintiff		[name]
#Second plaintiff #Number of plaintiffs (if more than two)
[First] defendant		[name]
#Second defendant #Number of defendants (if more than two)
ISSUING DETAILS
Issued for		[name] [role of party eg plaintiff] (judgment creditor)
#Legal representative		[solicitor on record] [firm]
#Legal representative reference		[reference number]
Contact name and telephone		[name] [telephone]
Contact email		[email address]
NOTICE TO JUDGMENT DEBTOR
[name] [role of party eg defendant] (judgment debtor)
Address

The court gave judgment against you on [date]. The judgment is still unsatisfied.

You must:

• #Complete the financial statement at the end of the document about your current income, assets and liabilities.
• #Make copies of the documents and things that you have been asked to produce and attach the copies to the examination notice.
• Sign the examination notice.
• Send the signed examination notice and the copies of the documents and things to the judgment creditor at the judgment creditor's address for service by [date].

If you do not comply, you may be ordered to attend court to provide this information to the court. If you are required to attend court to provide this information, additional costs will be incurred.

You can get further information on how to respond to this notice from:

• A legal practitioner.
• LawAccess NSW on 1300 888 529 or at www.lawaccess.nsw.gov.au.
• The court registry for limited procedural information.

SIGNATURE
#Signature of legal representative
#Signature of or on behalf of party if not legally represented
Capacity	[eg solicitor, authorised officer, role of party]
Date of signature

Financial Statement

INCOME (weekly unless otherwise stated)
Your average weekly income after tax from salary or wages				$
Social security benefits/pensions (include family payments etc)				$
All other income (eg self-employed income, interest, dividends, rent or trust distributions)				$
TOTAL				$
EMPLOYMENT DETAILS
What is the name of your employer?
What is the address of your employer?
SUBURB			POSTCODE
Is your salary or wage paid by your employer into an account in a bank or financial institution?
If you answered yes to the previous question, identify the institution, branch, BSB and account number.
PROPERTY OWNED BY YOU
				CURRENT VALUE
Home	PROPERTY ADDRESS			$
	VALUE OF EQUITY, IF ANY	$
Other property	PROPERTY ADDRESS			$
	VALUE OF EQUITY, IF ANY	$
Funds in banks/ financial institutions, including funds held in off-set accounts	INSTITUTION, BRANCH, BSB AND ACCOUNT NUMBER			$
	INSTITUTION, BRANCH, BSB AND ACCOUNT NUMBER			$
Investments	NAME AND TYPE OF INVESTMENT			$
Motor vehicle	YEAR	MAKE		$
	MODEL	REGISTRATION NO
Household contents				$
Other personal property	DESCRIPTION AND LOCATION			$
TOTAL VALUE OF PROPERTY OWNED BY YOU				$

[Add extra lines, if necessary, so that all details of income and assets are disclosed.]

LIABILITIES
Average weekly expenses:				Other liabilities:
ITEM		WEEKLY AMOUNT		LIABILITIES	NAME OF BANK/INSTITUTION	TOTAL AMOUNT OWED
Food		$		Home mortgage		$
Household supplies		$		Other loans		$
Mortgage/rent		$		Credit cards		$
Gas		$		Credit cards		$
Electricity		$		Other liabilities (specify)		$
Heating fuel		$
Rates/levies		$		TOTAL		$
Telephone		$
Motor vehicle
• Petrol		$
• Maintenance		$
• Registration/insurance		$
Medical/hospital funds		$
Other insurance (specify)		$
Fares		$
Clothing and shoes		$
Entertainment/hobbies		$
Education/childcare expenses, including fees and levies		$
Medical/chemist /pharmaceutical		$
Hire purchase payments		$
Credit cards		$
Other necessary commitments, including weekly payments on other liabilities, listed above (specify)		$
TOTAL WEEKLY EXPENSES		$	[Add extra lines, if necessary, so that all details of weekly expenses and liabilities are disclosed.]
Does anyone contribute to paying these liabilities (eg your spouse/partner)?						Yes No
If yes, give the person's details:
Name of person
Amount of contribution per week
Do you have any dependants?						Yes No
If yes, give details:
ADDITIONAL QUESTIONS REGARDING FINANCIAL CIRCUMSTANCES
Do you have any income, assets or liabilities not disclosed in this examination notice?
If you answered yes to the previous question, give details of the other income, assets (including their location) or liabilities.
What arrangements are you prepared to make to pay this debt?
#Additional questions
DOCUMENTS TO BE PRODUCED

Copies of the following documents must be attached by the judgment debtor and returned with this notice to the judgment creditor.

1. [ ]
2. [ ]

SIGNATURE OF JUDGMENT DEBTOR

The information contained in the financial statement in this examination notice is true.

I have attached copies of the documents that I have been asked to produce.

Signature
Date of signature
Telephone (Include your telephone number if you consent to being contacted by the [#judgment creditor #judgment creditor's solicitor] to clarify any of the information you have provided in this notice.)