Skip links and keyboard navigation

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.

  1. Part 1 - Income
    1. Current employment
      1. Are you currently employed? *
      2. Current employment details (If you chose ‘Yes’ above)
        1. Are these payments made directly into an account with a bank or financial institution? *
        2. Bank details (If you chose ‘Yes’ above)
          1. Please provide the relevant bank details below:
        3. Are any regular deductions made from the payments? *
    2. Previous employment
      1. Have you previously been employed? *
      2. Previous employment details (If you chose ‘Yes’ above)
    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
      2. Payments (If you chose ‘Yes’ above)
        1. Are you receiving another payment? *
        2. Second payment (If you chose ‘Second-payment’ above)
          1. Are you receiving another payment? *
          2. Third payment (If you chose ‘Third-payment’ above)
            1. Are you receiving another payment? *
            2. Fourth payment (If you chose ‘Fourth-payment’ above)
        3. Are the payments outlined above being made directly into an account with a bank or financial institution? *
        4. Bank details (If you chose ‘Yes’ above)
          1. Please provide the relevant bank details below:
    4. Self employment
      1. Are you self employed? *
      2. Self employment details (If you chose ‘Yes’ above)
    5. Miscellaneous income
      1. In the last 12 months, did you receive any income from any of the following sources?
      2. Dividends *
      3. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      4. Interest from banks, building societies, credit unions, other financial institutions, shares, etc. *
      5. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      6. Sale of shares *
      7. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      8. Money from trusts or estates *
      9. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      10. Drawings from business, partnership, company and trusts *
      11. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      12. Rent payments *
      13. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      14. Board payments *
      15. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      16. Worker’s compensation payments *
      17. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      18. Maintenance payments (child or spouse) *
      19. (If you chose ‘Yes’ above)
        1. When was this amount received? *
      20. Any other income from any source? *
      21. (If you chose ‘Yes’ above)
        1. When was this amount received? *
    6. Dependents
      1. Are you wholly or partly dependent on any other person for financial support? *
      2. (If you chose ‘Yes’ above)
        1. What is the name of the person?
      3. Is any other person wholly or partly dependent on you for financial support? *
      4. (If you chose ‘Yes’ above)
        1. What is the name of the person?
    7. Additional payments
      1. Are you expecting to receive a lump sum payment in the future? *
      2. Lump sum payment (If you chose ‘Yes’ above)
  2. Part 2 - Expenses
    1. Do you incur any expenses in obtaining any of the income disclosed above? (excluding expenses relating to self employment) *
    2. Expenses from obtaining income (If you chose ‘Yes’ above)
    3. Do you (not your employer on your behalf) make contributions to any superannuation funds? *
    4. Supperannuation fund (If you chose ‘Yes’ above)
    5. General expenses
      1. How much do you spend on a weekly basis on the following categories listed below?
      2. Please type 'Nil' if not applicable.
    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? *
      2. Details of agreement (If you chose ‘Yes’ above)
        1. Do you have another lease or hire purchase agreement? *
        2. Details of second agreement (If you chose ‘Second-agreement’ above)
          1. Do you have another lease or hire purchase agreement? *
          2. Details of third agreement (If you chose ‘Third-agreement’ above)
  3. 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)
    2. Interest in land (If you chose ‘Yes’ above)
      1. Do you hold that interest alone? *
    3. Do you have any money in bank accounts, building societies, credit unions or similar financial institutions? *
    4. Financial institutions (If you chose ‘Yes’ above)
    5. Do you have any life insurance policies? *
    6. Life insurance policies (If you chose ‘Yes’ above)
    7. Do you own any shares or debentures? *
    8. Shares and debentures (If you chose ‘Yes’ above)
    9. Do you hold an interest in any business, partnership etc? *
    10. Businesses / Partnerships (If you chose ‘Yes’ above)
    11. Do you have an interest in any deceased estate or trust? *
    12. Deceased estate or trust (If you chose ‘Yes’ above)
    13. Do you have an interest in any superannuation fund? *
    14. Superannuation fund (If you chose ‘Yes’ above)
    15. Is there any money owing to you from any source? *
    16. Debt owed (If you chose ‘Yes’ above)
      1. Is the money owing under an agreement in writing? *
      2. (If you chose ‘Yes’ above)
        1. Please provide a copy of the agreement.
    17. Do you have any money on hand? *
    18. Money on hand (If you chose ‘Yes’ above)
    19. Do you own any vehicles? *
    20. Vehicles (If you chose ‘Yes’ above)
    21. Do you own any caravans, boats, trailers, jet skis or other similar items? *
    22. Other items (If you chose ‘Yes’ above)
    23. Do you own any furniture and/or other household goods? * (e.g. whitegoods, appliances)
    24. Household goods (If you chose ‘Yes’ above)
    25. Do you own any jewellery and/or other personal effects? *
    26. Personal effects (If you chose ‘Yes’ above)
    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)
    28. Other property (If you chose ‘Yes’ above)
  4. Part 4 - Liabilities
    1. Have you mortgaged or charged any property? *
    2. Mortgaged or charged property (If you chose ‘Yes’ above)
      1. Is the mortgaged or charged property registered? *
    3. Do you have any bank loans or overdrafts? *
    4. Bank loans or overdrafts (If you chose ‘Yes’ above)
      1. Is the loan or overdraft secured against any asset? *
    5. Do you have any credit cards? *
    6. Credit cards (If you chose ‘Yes’ above)
    7. Do you owe any money other than as disclosed above? * (e.g. tax liabilities)
    8. Other debt (If you chose ‘Yes’ above)
    9. Have you guaranteed the debts of any other person or corporation? *
    10. Guaranteed debts (If you chose ‘Yes’ above)
      1. Is the guarantee wholly or partly in writing? *
      2. (If you chose ‘Yes’ above)
        1. Please provide a copy of the written guarantee.
  5. Part 5 - Enforcement Creditor
    1. Enforcement creditor's address (if known)
    2. Do you have any proposal for the payment or satisfaction of the debt to the enforcement creditor? *
    3. Proposal for payment (If you chose ‘Yes’ above)
  6. Verification of statement
    1. Please enter your contact details and complete the acknowledgements to verify your statement.
    2. Name
    3. Address
    4. Acknowledgement
      •  
Last updated
20 October 2015
  1. Is your feedback about:
  2. (If you chose ‘website’ above)

    Page feedback

    1. How satisfied are you with your experience today? *
  3. (If you chose ‘service’ above)

    Feedback on government services, departments and staff

    Please use our complaints and compliments form.