Form
47 (version 4)
UCPR
37.2
NOTICE
OF MOTION
TO PAY BY
INSTALMENTS - CORPORATION
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COURT DETAILS |
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Court
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#Division
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#List
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Registry
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Case number
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TITLE OF PROCEEDINGS |
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#Second plaintiff #Number of
plaintiffs (if more than two)
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[First] defendant
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[name]
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#Second defendant #Number of
defendants (if more than two)
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FILING DETAILS |
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Person seeking orders
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#Filed in relation to
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#Legal representative
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[solicitor on record] [firm]
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#Legal representative reference
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[reference number]
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Contact name and telephone
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[name] [telephone]
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Contact email
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[email address]
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PERSON AFFECTED BY ORDERS SOUGHT |
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HEARING DETAILS |
This motion is to
be dealt with in the absence of the parties.
COURT USE ONLY
Application granted/refused
If refused, state reason
Signature of registrar
Date
[on separate page]
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ORDERS SOUGHT |
The judgment debt
be paid by the judgment debtor to the judgment creditor, by
instalments on the following terms:
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Amount
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Frequency
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First payment
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SIGNATURE |
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#Signature of legal representative
#Signature of or on behalf of party
if not legally represented
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AFFIDAVIT |
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Name
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Address
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Occupation
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Date
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- I believe that the information about the company’s present income, assets and liabilities contained in the financial statement that is annexed to this affidavit is true.
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#SWORN #AFFIRMED at
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Signature of deponent
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Name of witness
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Address of witness
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Capacity of witness
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[#Justice of the peace #Solicitor #Barrister #Commissioner for affidavits #Notary public]
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And
as a witness, I certify
the following matters concerning the person who made this
affidavit (the deponent):
1 #I
saw the face of the deponent. [OR,
delete whichever option is inapplicable]
#I
did not see the face of the deponent because the deponent was
wearing a face covering, but I am satisfied that the deponent had
a special justification for not removing the covering.*
2 #I have known the deponent
for at least 12 months. [OR,
delete whichever option is inapplicable]
#I
have confirmed the deponent’s identity using the following
identification document:
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Identification document relied
on (may be original or certified copy)
†
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Signature of witness
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Note:
The deponent and witness must sign each page of the affidavit. See
UCPR 35.7B.
____________________________
[*
The only "special justification" for not removing a face
covering is a legitimate medical reason (at April 2012).]
[†"Identification
documents" include current driver licence, proof of age card,
Medicare card, credit card, Centrelink pension card, Veterans Affairs
entitlement card, student identity card, citizenship certificate,
birth certificate, passport or see Oaths Regulation 2011.]
Note
1: The making of a false statement or the giving of false
information in an affidavit is perjury and is an offence punishable
by law under the Oaths Act 1900 (NSW).
Note
2: The witness must also sign the annexure certificate endorsed on
the financial statement.
Financial Statement
[Add extra lines, if necessary, so that all details of income, assets and liabilities are disclosed.]
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INCOME
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Estimated gross annual
income of business
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$
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Nature of business
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ASSETS
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Real estate
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$
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Funds in
banks/financial institutions, including funds held in off-set
accounts
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$
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Investments
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$
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Motor vehicle
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$
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Sundry debtors
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$
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Tools and equipment
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$
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TOTAL VALUE OF
ASSETS
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$
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LIABILITIES
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Average annual
expenses (eg wages, materials, rent, utilities,
insurance, superannuation, workers compensation, payments on liabilities listed below) |
$
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OTHER LIABILITIES:
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NAME OF BANK/INSTITUTION |
TOTAL AMOUNT OWED |
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Mortgage
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$ |
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Other loans
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$ |
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Credit cards
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$ |
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Other
liabilities
(specify) |
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$ |
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TOTAL
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$ |
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This is the annexure referred to in the affidavit of [name] [#sworn #affirmed]
before me on [date].
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Signature of witness |
[on separate page]
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JUDGMENT DEBTOR'S DETAILS
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Name
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Address |
#[unit/level number] #[building name]
[street number] [street name] [street type]
[suburb/city] [state/territory] [postcode] |
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#Telephone |
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#Fax |
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#Email |
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