Complete the statement of financial position form

You can use this online form if you are a debtor who has been sent a notice to complete a statement of financial position.

To complete this form, you will need details of:

past and present employment
any pensions and benefits you receive
self employment (if applicable)
any other income
dependants
general expenses, lease or hire purchase agreements
any assets you own (land / property, vehicles, shares, businesses, household goods, etc)
any debts (including loans, credit cards, etc).

You must make every attempt to find out and enter the correct dollar amount. If you have tried, but you are still unable to do so, you will need to estimate an amount. In this case, you should insert the letter 'E' before the estimated amount you enter.

This form may take up to 30 minutes to complete.

Part 1 - Income
1. Current employment
  1. Are you currently employed? *
    Yes
    
    No
  2. Current employment details (If you chose ‘Yes’ above)
    What is your employer's name? *
    
    What is your employer's address? *
    
    What is your position within the company? *
    
    When did you start working in this job? *
    
    What amount do you earn (after deduction of tax) per week from this employment? * If the amount varies from week to week, state a typical amount.
    
    Please list the last 4 dates you received a payment from your employer. *
    
    Are these payments made directly into an account with a bank or financial institution? *
    Yes
    
    No
    
    Bank details (If you chose ‘Yes’ above)
    Please provide the relevant bank details below:
    
    Bank or financial institution *
    
    Account name *
    
    BSB number *
    
    Account number *
    
    Are any regular deductions made from the payments? *
    Yes
    
    No
    
    What is the deduction for and how much is deducted weekly? * (If you chose ‘Yes’ above)
2. Previous employment
  1. Have you previously been employed? *
    Yes
    
    No
  2. Previous employment details (If you chose ‘Yes’ above)
    On what date did your last period of employment end? *
    
    How long did you work in this job? *
    
    What is the name of your last employer? *
    
    What is the address of your last employer? *
    
    What amount did you earn (after deduction of tax) per week from this employment? * If the amount varies from week to week, state a typical amount.
3. Pensions / Benefits
  1. Do you receive any pensions, benefits, annuities or other similar payment from any government department, former employer, superannuation fund or other body? * View glossary of terms
    Yes
    
    No
  2. Payments (If you chose ‘Yes’ above)
    Who issues this payment? * (e.g. CentreLink)
    
    Why do you receive this payment? * (e.g. disability pension)
    
    How much do you receive per week? *
    
    What is the amount (if any) deducted for tax? *
    
    Are you receiving another payment? *
    Yes
    
    No
    
    Second payment (If you chose ‘Second-payment’ above)
    Who issues this payment? * (e.g. CentreLink)
    
    Why do you receive this payment? * (e.g. disability pension)
    
    How much do you receive per week? *
    
    What is the amount (if any) deducted for tax? *
    
    Are you receiving another payment? *
    Yes
    
    No
    
    Third payment (If you chose ‘Third-payment’ above)
    Who issues this payment? * (e.g. CentreLink)
    
    Why do you receive this payment? * (e.g. disability pension)
    
    How much do you receive per week? *
    
    What is the amount (if any) deducted for tax? *
    
    Are you receiving another payment? *
    Yes
    
    No
    
    Fourth payment (If you chose ‘Fourth-payment’ above)
    Who issues this payment? * (e.g. CentreLink)
    
    Why do you receive this payment? * (e.g. disability pension)
    
    How much do you receive per week? *
    
    What is the amount (if any) deducted for tax? *
    
    Are the payments outlined above being made directly into an account with a bank or financial institution? *
    Yes
    
    No
    
    Bank details (If you chose ‘Yes’ above)
    Please provide the relevant bank details below:
    
    Bank or financial institution *
    
    Account name *
    
    BSB number *
    
    Account number *
4. Self employment
  1. Are you self employed? *
    Yes
    
    No
  2. Self employment details (If you chose ‘Yes’ above)
    What is your occupation? *
    
    What is the total amount received by you as a self-employed person during the last financial year? *
    
    What is the total amount of expenditure incurred by you in earning income during that financial year? *
5. Miscellaneous income
  1. In the last 12 months, did you receive any income from any of the following sources?
  2. Dividends *
    Yes
    
    No
  3. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  4. Interest from banks, building societies, credit unions, other financial institutions, shares, etc. *
    Yes
    
    No
  5. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  6. Sale of shares *
    Yes
    
    No
  7. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  8. Money from trusts or estates *
    Yes
    
    No
  9. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  10. Drawings from business, partnership, company and trusts *
    Yes
    
    No
  11. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  12. Rent payments *
    Yes
    
    No
  13. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  14. Board payments *
    Yes
    
    No
  15. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  16. Worker’s compensation payments *
    Yes
    
    No
  17. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  18. Maintenance payments (child or spouse) *
    Yes
    
    No
  19. (If you chose ‘Yes’ above)
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
  20. Any other income from any source? *
    Yes
    
    No
  21. (If you chose ‘Yes’ above)
    Who issued the payment? *
    
    Total amount received? *
    
    When was this amount received? *
    Last 12 months
    
    Last financial year
6. Dependents
  1. Are you wholly or partly dependent on any other person for financial support? *
    Yes
    
    No
  2. (If you chose ‘Yes’ above)
    
    What is the name of the person?
    Given name *
    
    Family name *
    
    What is your relationship with this person? *
    
    What is the average weekly value of the support? *
  3. Is any other person wholly or partly dependent on you for financial support? *
    Yes
    
    No
  4. (If you chose ‘Yes’ above)
    
    What is the name of the person?
    Given name *
    
    Family name *
    
    What is your relationship with this person? *
    
    What is the average weekly value of the support? *
7. Additional payments
  1. Are you expecting to receive a lump sum payment in the future? *
    Yes
    
    No
  2. Lump sum payment (If you chose ‘Yes’ above)
    Where will the payment be coming from? *
    
    What is the amount of the payment? *
    
    What is the expected date of the payment? *
Part 2 - Expenses
1. Do you incur any expenses in obtaining any of the income disclosed above? (excluding expenses relating to self employment) *
  - Yes
  - No
2. Expenses from obtaining income (If you chose ‘Yes’ above)
  1. What are the details of the expenses incurred? *
  2. What is the average weekly value of the expenses? *
3. Do you (not your employer on your behalf) make contributions to any superannuation funds? *
  - Yes
  - No
4. Supperannuation fund (If you chose ‘Yes’ above)
  1. What is the name of the superannuation fund? *
  2. What is the total contribution made by you in the last 12 months? *
5. General expenses
  1. How much do you spend on a weekly basis on the following categories listed below?
  2. Food and household supplies *
  3. Accommodation expenses * (including rent, board, hospital, nursing home etc. but excluding mortgage payments)
  4. Rates, body corporate levies and land tax *
  5. Home maintenance and repairs *
  6. Lay-by payments *
  7. Electricity, gas, telephone (including mobile telephones) and internet expenses *
  8. Mortgage payments *
  9. Child care *
  10. Child maintenance *
  11. Medical, dental, optical, ambulance and pharmacy *
  12. Clothing and shoes *
  13. School fees and other educational expenses *
  14. Insurance policy premiums *
  15. Public transport fares *
  16. Vehicle expenses * (including registration, insurance, maintenance and running costs)
  17. Entertainment and other recreational expenses *
  18. Union or association fees *
  19. Any other weekly expenses - give details *
6. Lease or hire purchase agreements
  1. Do you have any goods or assets (not real property) subject to a lease or hire purchase agreement? *
    Yes
    
    No
  2. Details of agreement (If you chose ‘Yes’ above)
    What is the lease / agreement for? *
    
    What is the name of the hire purchase company or lessor? *
    
    How often do you make payments? *
    
    How much do you usually pay? *
    
    What is the balance owing under the lease / agreement? *
    
    How much has been paid under the lease / agreement to date? *
    
    When did the lease / agreement start? *
    
    What is the residual value, if any, of the lease property? * View glossary of terms
    
    Do you have another lease or hire purchase agreement? *
    Yes
    
    No
    
    Details of second agreement (If you chose ‘Second-agreement’ above)
    What is the lease / agreement for? *
    
    What is the name of the hire purchase company or lessor? *
    
    How often do you make payments? *
    
    How much do you usually pay? *
    
    What is the balance owing under the lease / agreement? *
    
    How much has been paid under the lease / agreement to date? *
    
    When did the lease / agreement start? *
    
    What is the residual value, if any, of the lease property? * View glossary of terms
    
    Do you have another lease or hire purchase agreement? *
    Yes
    
    No
    
    Details of third agreement (If you chose ‘Third-agreement’ above)
    What is the lease / agreement for? *
    
    What is the name of the hire purchase company or lessor? *
    
    How often do you make payments? *
    
    How much do you usually pay? *
    
    What is the balance owing under the lease / agreement? *
    
    How much has been paid under the lease / agreement to date? *
    
    When did the lease / agreement start? *
    
    What is the residual value, if any, of the lease property? * View glossary of terms
Part 3 - Assets
1. Do you own or have any interest in any land, either alone or with others? * (including any house, home unit, farm, or tenancy of any property)
  - Yes
  - No
2. Interest in land (If you chose ‘Yes’ above)
  1. Please describe the property * (e.g. house, home unit, farm)
  2. Where is the property located? *
  3. What interest do you have in the property? * (e.g. owner / tenant)
  4. Do you hold that interest alone? *
    Yes
    
    No
  5. Who else has an interest in the land, and what is the extent of their interests? (If you chose ‘No’ above) *
  6. What is the value of your interest in the land? *
3. Do you have any money in bank accounts, building societies, credit unions or similar financial institutions? *
  - Yes
  - No
4. Financial institutions (If you chose ‘Yes’ above)
  1. What is the name of the institution? *
  2. What name is the account in? *
  3. What is the account number? *
  4. What is the current amount in the account? *
5. Do you have any life insurance policies? *
  - Yes
  - No
6. Life insurance policies (If you chose ‘Yes’ above)
  1. What is the name of the insurer? *
  2. What is the policy number? *
  3. What is the surrender value? *
7. Do you own any shares or debentures? *
  - Yes
  - No
8. Shares and debentures (If you chose ‘Yes’ above)
  1. What is the name of the corporation which has issued the shares or debentures? *
  2. What is the description and number of the shares or debentures? *
  3. What is the current market value of the shares or debentures? *
9. Do you hold an interest in any business, partnership etc? *
  - Yes
  - No
10. Businesses / Partnerships (If you chose ‘Yes’ above)
  1. What is the name of the business / partnership? *
  2. What is the current market value of the business / partnership? *
  3. What is the name of the holder of any other interest and the extent of that interest? *
11. Do you have an interest in any deceased estate or trust? *
  - Yes
  - No
12. Deceased estate or trust (If you chose ‘Yes’ above)
  1. What is the name of the estate or trust? *
  2. What is the nature and extent of your interest? *
  3. What is the value of your interest? *
13. Do you have an interest in any superannuation fund? *
  - Yes
  - No
14. Superannuation fund (If you chose ‘Yes’ above)
  1. What is the name of the fund? *
  2. What is the nature and present value of your interest? *
  3. What is the date and amount of expected distribution from the fund? *
15. Is there any money owing to you from any source? *
  - Yes
  - No
16. Debt owed (If you chose ‘Yes’ above)
  1. Is the money owing under an agreement in writing? *
    Yes
    
    No
  2. (If you chose ‘Yes’ above)
    Please provide a copy of the agreement.
  3. Who owes you the money? *
  4. What is the amount owed? *
  5. When is the debt likely to be repaid? *
17. Do you have any money on hand? *
  - Yes
  - No
18. Money on hand (If you chose ‘Yes’ above)
  1. What is the amount? *
  2. Where is the money held? *
19. Do you own any vehicles? *
  - Yes
  - No
20. Vehicles (If you chose ‘Yes’ above)
  1. For each vehicle, please state the make, model, year, registration number and current market value. *
21. Do you own any caravans, boats, trailers, jet skis or other similar items? *
  - Yes
  - No
22. Other items (If you chose ‘Yes’ above)
  1. For each item, please state the make, model, year, registration number and current market value. *
23. Do you own any furniture and/or other household goods? * (e.g. whitegoods, appliances)
  - Yes
  - No
24. Household goods (If you chose ‘Yes’ above)
  1. Please identify any significant items *
  2. What is the estimated value of these items? *
25. Do you own any jewellery and/or other personal effects? *
  - Yes
  - No
26. Personal effects (If you chose ‘Yes’ above)
  1. Please identify any significant items *
  2. What is the estimated value of these items? *
27. Do you own or have any interest in any property of any kind, including intellectual property, goodwill, stock in trade, livestock, artwork other than as set out above? * (e.g. business or product names, trademarks, computer software, domain names)
  - Yes
  - No
28. Other property (If you chose ‘Yes’ above)
  1. Please identify any significant items *
  2. What is the estimated value of these items? *
Part 4 - Liabilities
1. Have you mortgaged or charged any property? *
  - Yes
  - No
2. Mortgaged or charged property (If you chose ‘Yes’ above)
  1. Is the mortgaged or charged property registered? *
    Yes
    
    No
  2. What is the registered number and date of registration? (If you chose ‘Yes’ above) *
  3. What is the name of the mortgagee or chargee? * View glossary of terms
  4. What are the details of the encumbered property? * View glossary of terms
  5. What is the total amount owing? *
  6. How often are payments made? * (e.g. weekly, monthly)
  7. What is the average amount of each payment? *
3. Do you have any bank loans or overdrafts? *
  - Yes
  - No
4. Bank loans or overdrafts (If you chose ‘Yes’ above)
  1. What is the name of the bank or financial institution? *
  2. What is the total amount owing? *
  3. What is the limit of the overdraft? *
  4. How often are payments made? * (e.g. weekly, monthly)
  5. What is the average amount of each payment? *
  6. Is the loan or overdraft secured against any asset? *
    Yes
    
    No
  7. Please describe the asset (If you chose ‘Yes’ above) *
  8. What are the minimum requirements for repayments? *
5. Do you have any credit cards? *
  - Yes
  - No
6. Credit cards (If you chose ‘Yes’ above)
  1. What is the name of the financial institution which issued the card? *
  2. What is the debit balance of the card? *
7. Do you owe any money other than as disclosed above? * (e.g. tax liabilities)
  - Yes
  - No
8. Other debt (If you chose ‘Yes’ above)
  1. What is the name of the creditor? *
  2. What is the amount owing? *
  3. How often are payments made? * (e.g. weekly, monthly)
  4. What is the average amount of each payment? * (e.g. weekly, monthly)
  5. When is the debt payable? *
9. Have you guaranteed the debts of any other person or corporation? *
  - Yes
  - No
10. Guaranteed debts (If you chose ‘Yes’ above)
  1. What is the name of the principal debtor? *
  2. What is the name of the principal creditor? *
  3. Is the guarantee wholly or partly in writing? *
    Yes
    
    No
  4. (If you chose ‘Yes’ above)
    Please provide a copy of the written guarantee.
    
    What is the monetary limit of the guarantee? *
Part 5 - Enforcement Creditor
1. Who is the enforcement creditor? * Who sent you this form to fill out / who is your debt with
2. Enforcement creditor's address (if known)
  1. Address line 1
  2. Address line 2
  3. Town, city or suburb
    
    State
    
    Postcode
3. Do you have any proposal for the payment or satisfaction of the debt to the enforcement creditor? *
  - Yes
  - No
4. Proposal for payment (If you chose ‘Yes’ above)
  1. Please set out the proposal *
5. What court registry is your matter listed with? You can find this information on the documentation sent to you by the enforcement creditor
6. What is the court file number? You can find this information on the documentation sent to you by the enforcement creditor
Verification of statement
1. Please enter your contact details and complete the acknowledgements to verify your statement.
2. Name
  1. Given name *
  2. Family name *
3. Occupation *
4. Address
  1. Address line 1 *
  2. Address line 2
  3. Town, city or suburb *
    
    State *
    
    Postcode *
5. Acknowledgement
  - Acknowledgement The information set out in this statement is true and correct to the best of my knowledge and belief. Where I have given an estimate in this statement, it is given in good faith to the best of my knowledge and belief.
  - Acknowledgement To the best of my knowledge and belief I have no income, property or financial resources other than as set out in this statement.

Last updated:: 20 October 2015

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