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Rules of the Superior Courts

Appendix: O

Bankruptcy Act 1988 and Personal Insolvency Act 2012
[as amended by S.I. Nos. 79 of 1989, 120 of 2012, 316 of 2013, 461 of 2013 & 507 of 2015]


The below amendment(s) have been made to this instrument which can be viewed by clicking on the link(s):

No-S.I. No. 585 Of 2001: Rules Of The Superior Courts (No. 4) (Euro Changeover), 2001



Forms:
No.1 ¦ No.2 ¦ No.3 ¦ No.4 ¦ No.5 ¦ No.6 ¦ No.7 ¦ No.8 ¦ No.9 ¦ No.10 ¦ No.11 ¦ No.12 ¦ No.13 ¦ No.14 ¦ No.15 ¦ No.16 ¦ No.17 ¦ No.18 ¦ No.19 ¦ No.20 ¦ No.21 ¦ No.21A ¦ No.22 ¦ No.23 ¦ No.24 ¦ No.25 ¦ No.31 ¦ No.32 ¦ No.33 ¦ No.34 ¦ No.34A ¦ No.35 ¦ No.36 ¦ No.37 ¦ No.38 ¦ No.39 ¦ No.40 ¦ No.41 ¦ No.42 ¦ No.43 ¦ No.44 ¦ No.45 ¦ No.46 ¦ No.47 ¦ No.48 ¦ No.49 ¦ No.50 ¦ No.51 ¦ No.52 ¦ No.53 ¦ No.54 ¦ No.55 ¦ No.56 ¦ No.57 ¦ No.58 ¦ No.59
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S.I. No. 461 of 2013

No. 1.

THE HIGH COURT

BANKRUPTCY

BANKRUPTCY SUMMONS


To ................. of .................

Not less than 14 days’ notice having been sent to you on the ....... day of .......... 20.... of the under-mentioned creditor’s intention to apply for a bankruptcy summons and the debt concerned remaining unpaid.

You are hereby warned that unless within 14 days after the service of this summons on you, you do pay to ........... of ................. the sum of ........ euro and ......... cent, being the sum claimed of you by ............... according to the particulars hereunto annexed or endorsed hereon, or unless you shall secure or compound for the same to *his *her *its satisfaction, you will have committed an act of bankruptcy, in respect of which you may be adjudged a bankrupt, on a petition being presented against you by the said ... unless you shall have within the time aforesaid applied to the Court to dismiss this summons, on the ground that you are not indebted to the said... in any sum or that you are only indebted to ........ in a sum of €20,000 or less, or that before service of this summons upon you, you had obtained the protection of the Court.

Issued pursuant to the provisions of section 8 of the Bankruptcy Act 1988. Given under the seal of the Court this ....... day of ........ 20......

(Signed) Judge


You are specially to note:

That the consequences, which will follow any neglect to comply with the requisitions contained in the summons, are that you may be adjudged a bankrupt on a petition of bankruptcy being presented against you by the said...

If, however, you are not indebted to the said ......... in any sum, or you are only indebted to .............. in a sum of €20,000 or less, you must apply to the Court to dismiss this summons within fourteen days after service of this summons on you, by filing in the Examiner's Office, Four Courts, Dublin, an affidavit in the prescribed form (Form No. 6, Appendix O of the Rules of the Superior Courts), stating that

      (a) you are not so indebted, or only so indebted to an amount of €20,000 or less, or

      (b) before service of this summons upon you, you had obtained the protection of the Court, or had compounded or secured for the debt to the satisfaction of the said .....

and on your applying to dismiss the summons a date will be fixed for the hearing of your application.

(Signed)

Solicitor for the said

[Address]


PARTICULARS OF DEMAND
[set out in detail]

*delete where inapplicable

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S.I. No. 461 of 2013

No. 2

SUMMONS — TWO OR MORE CREDITORS NOT PARTNERS

THE HIGH COURT

BANKRUPTCY

BANKRUPTCY SUMMONS


To ................. of .................

Not less than 14 days’ notice having been sent to you on the ...... day of ................. 20......... of the under-mentioned creditor’s intention to apply for a bankruptcy summons and the debt concerned remaining unpaid.

You are hereby warned that, unless within 14 days after the service of this summons on you, you do pay to ....... of ........ the sum of ... euro and ... cent, and to ........ of ........ the sum of ...... euro and ... cent, and to ......... of ........ the sum of ... euro and ... cent, being the sums claimed of you by them according to the particulars hereunto annexed, or endorsed hereon, or unless you shall secure or compound for the same to their satisfaction respectively, you will have committed an act of bankruptcy, in respect of which you may be adjudged a bankrupt on a petition being presented against you by the said ...... and the said ...... unless you shall have, within the time aforesaid, applied to the Court to dismiss this summons, on the ground that you are not indebted to ........ or only indebted to ....... in a sum of €20,000 or less or that before service of this summons upon you, you had obtained the protection of the Court.

Issued pursuant to the provisions of section 8 of the Bankruptcy Act 1988. Given under the seal of the Court, this ...... day of ................. 20........

(Signed) Judge


You are specially to note:

That the consequences which will follow any neglect to comply with the requisitions contained in the summons are that you may be adjudged a bankrupt on a petition of bankruptcy being presented against you by the said... and the said...

If, however, you are not indebted to the said ... or .......... in any sum or you are only indebted to them in a sum of €20,000 or less, you must apply to the Court to dismiss this summons, within fourteen days after service of this summons on you, by filing in the Examiner's Office, Four Courts, Dublin, an affidavit in the prescribed form (Form No. 6, Appendix O of the Rules of the Superior Courts), stating that

      (a) you are not so indebted, or only so indebted to a amount of €20,000 or less, or

      (b) that before service of this summons upon you, you had obtained the protection of the Court, or had compounded or secured for the debt to the satisfaction of the said ... and on your applying to dismiss the summons a day will be fixed for the hearing of your application.

(Signed) Solicitor for the said

[Address]


PARTICULARS OF DEMAND

[set out in detail]

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No. 3.
AFFIDAVIT OF SERVICE OF BANKRUPTCY SUMMONS
THE HIGH COURT
BANKRUPTCY
In the matter of a petition for adjudication of bankruptcy by ... of ... against ... of ...
I, ... of ... aged 16 years and upwards, make oath and say as follows;—
1. I did on the ... day of ... 19 ... , personally serve the said ... with a sealed copy of the Bankruptcy Summons and sealed copy of the particulars of demand thereto annexed, the originals whereof respectively are hereto annexed, by delivering unto and leaving the same with the said ... at ...
2. At the time of such service I showed unto the said ... the said original Summons and particulars of demand, and I was at the time aforesaid acquainted with the appearance of the said ...
3. On the ... day of ... 19 ... , being within three days of such service, I endorsed upon the said original Summons the hour and day of the week, month and year of such service.
Sworn, &c.
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S.I. No. 461 of 2013

No. 4
PARTICULARS OF DEMAND, AND NOTICE REQUIRING PAYMENT PRIOR TO THE ISSUE OF A BANKRUPTCY SUMMONS.

To:

The following are the particulars of the demand of the undersigned ........ of ............ against you the said ......... amounting to the sum of € ........


[detailed particulars to be given]

Take notice that the said ...... hereby requires immediate payment of the said sum of ........... within fourteen days of service of this Notice upon you at the address given below and failing payment within that period, I will apply to the High Court for the issue of a bankruptcy summons against you in accordance with section 8 of the Bankruptcy Act 1988.

Dated

(Signed)

(State capacity Address)


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No. 5.
AFFIDAVIT FOR BANKRUPTCY SUMMONS
THE HIGH
BANKRUPTCY
I, ....... (if not creditor, state capacity) make oath and say as follows:
1. ... of ... is justly and truly indebted to ... in the sum of ... pounds, ... pence for (state nature of debt).
2. An account in writing of the particulars of demand and notice requiring payment was on or about the ... day of ... 19 ... , sent by post (or as the case may be) addressed to the said ... at ..... aforesaid, and payment of the same has been on more than one occasion required of him.
3. I, ... the said ... hold no security or bills or notes for the said debt save as follows:—
4. No form of execution has issued in respect of the said debt and remains to be proceeded upon.
5. I therefore pray this Honourable Court for an Order that a Bankruptcy Summons do issue against the said
Sworn, &c.
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S.I. No. 461 of 2013


No. 6.

AFFIDAVIT TO GROUND APPLICATION TO DISMISS BANKRUPTCY SUMMONS

THE HIGH COURT BANKRUPTCY


In the matter of a Bankruptcy Summons by ..... against ....... of ....... and bearing date the ....... day of ...... 20........

I, the above-named ................. make oath and say that the above-named summons was served on me on the ...... day of ........ 20......., and that

†I am not indebted to the said ................. in any sum amounting to more than €20,000.

†before such service I had obtained the protection of the Court.

†I have compounded for the debt to the satisfaction of the said ................. in the following manner:—*

†I have secured ........ for the debt to the satisfaction of the said ....... in the following manner:—*

Sworn, &c.

Delete where inapplicable

*Set out in detail.

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No. 7.
NOTICE OF APPLICATION TO DISMISS BANKRUPCTY SUMMONS
THE HIGH COURT
BANKRUPTCY
In the matter of a Bankruptcy Summons by ... of ... dated the ... day of ... 19 .
Notice is hereby given that an affidavit of the said ... has been filed in the proper office and that the application of the said ... to dismiss the said Summons will be heard by the Court on ... day, the ... day of ... 19 ... at the hour of eleven o'clock in the forenoon.
Dated
(Signed)
To ... Examiner.
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No. 8.
NOTICE OF SUBSTITUTED SERVICE OF BANKRUPTCY SUMMONS BY ADVERTISEMENT
THE HIGH COURT
BANKRUPTCY
To ... of ... in the matter of a Bankruptcy Summons issued against you by ... of ...
Take notice, that a Bankruptcy Summons having been granted against you by this Court, the Court has ordered that the publication of this notice in ... shall be deemed to be service of such summons on you on the ... day after such publication.
A copy of the summons may be inspected by you in the Examiner's Office, Four Courts, Dublin.
Dated
(Signed)
Examiner.
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S. I. No. 120 of 2012

No. 9

DECLARATION OF INSOLVENCY

THE HIGH COURT

BANKRUPTCY


I, ......... of ............ do hereby declare that I am unable to meet my engagements with my creditors. My unencumbered assets are as follows: .............*

My encumbered assets are as follows: ..............*

My unsecured liabilities are as follows: ............*

My secured liabilities are as follows: .................*

†My centre of main interests is situated within the territory of the State, namely at ............

†My centre of main interests is situated within the territory of the State of ........ namely at .........., and I have an establishment within the territory of the State, at ............

Dated

(Signed)

Witness

Solicitor

Received the ........ day of ......... 20..... at the hour of ...... o'clock in the ......... noon.

*Set out in detail, specifying estimated value of each asset, amount of indebtedness secured upon the encumbered assets, and the assets upon which liabilities are secured, where appropriate.

†Delete whichever is inapplicable.


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No. 10.
AFFIDAVIT TO VERIFY DECLARATION OF INSOLVENCY
THE HIGH COURT
BANKRUPTCY
In the matter of a declaration of insolvency by ...
I, ... of ... solicitor, make oath and say I was present and did see the said ... sign the declaration of insolvency, dated the ... day of ... 19 ..., to which I have subscribed my name as witness. And I say that previously to the said ... signing the said declaration of insolvency, I explained to him the nature and purport thereof, and that when the same should be filed in the proper office, he would have committed an act of bankruptcy. And I say that the name ... subscribed as a witness to the said declaration is my proper name and handwriting.
Sworn, &c.
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S.I. No. 232 of 2016

No. 11

PETITION OF BANKRUPTCY BY A PERSON OTHER THAN THE DEBTOR

THE HIGH COURT


The petition of ........ of ........ shows as follows:-

[Note 1] 1. ........... of ......... (in this petition referred to as “the debtor”) is indebted to your petitioner in the sum of € ..... in respect of (state nature of debt).

2. Your petitioner does not nor does any person or persons on your petitioner’s behalf hold any mortgage, charge, or lien on the debtor’s estate or any part thereof as security for said debt or any part thereof (or your petitioner holds security for the payment of (or part of) the said sum but he will give up such security for the benefit of the creditors of the debtor in the event of the debtor’s being adjudged a bankrupt or your petitioner holds security for the payment of (or part of) the said sum and he estimates the value of such security at the sum of € ...... ).

3. The said debtor has within three months before the presentation of this petition committed an act of bankruptcy as follows:-(give details of the specific acts of bankruptcy alleged) as your petitioner has been informed and believes.

[Note 2] 4. Council Regulation (EC) No 1346/2000 applies to the proceedings. The centre of main interests (as determined in accordance with Council Regulation (EC) No 1346/2000) of the said debtor is situated in the State because (state facts and grounds relied on).

[Note 2]4. Council Regulation (EC) No 1346/2000 applies to the proceedings. The centre of main interests of the said debtor is situated within the territory of a Member State of the European Union in which Council Regulation (EC) No 1346/2000 applies (other than the State), namely at ....... in ......... because (state facts and grounds relied on) and the said debtor has an establishment within the State at ........ because (state facts and grounds relied on).

[Note 2] [Note 3] 4. Council Regulation (EC) No 1346/2000 does not apply to the proceedings because (state facts and grounds relied on), and the debtor is domiciled in the State (or specify which of the alternative requirements of Section 11(1)(d) of the Bankruptcy Act 1988 is fulfilled).

[Note 4] 5. To your petitioner’s knowledge, no insolvency proceedings have been opened in respect of the said debtor in a Member State of the European Union to which Council Regulation (EC) No 1346/2000 applies.

5. Insolvency proceedings, which are

*main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000)

*secondary proceedings, (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000)

*territorial proceedings, (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000)

have been opened in respect of the said debtor in a Member State of the European Union to which Council Regulation (EC) No 1346/2000 applies (other than the State), namely in .............., by decision of ...... made on ....... 20....

*Your petitioner

*....... of ........

was appointed by the said decision to be liquidator (within the meaning of Article 2(b) of Council Regulation (EC) No 1346/2000) in those insolvency proceedings concerning the debtor.

*6. (Where territorial proceedings are sought and no main proceedings are open in another EU Member State) In your petitioner’s belief, the centre of the debtor’s main interests is situated within the territory of a Member State other than the State, and main proceedings have not been opened in another Member State. The condition referred to in *[Article 3(4)(a)] *[Article 3(4)(b)] of Council Regulation (EC) No 1346/2000 is met because (state facts and grounds relied on, e.g. main proceedings cannot be opened in respect of the debtor where the centre of the debtor’s main interests is situated, because of the conditions laid down by the law of that State, or the opening of territorial insolvency proceedings is requested by a creditor who has his/her domicile, habitual residence or registered office in the State or whose claim arises from the operation of that establishment).

7. Your petitioner *has/*has not, prior to presenting this petition, received a proposal for a Debt Settlement Arrangement or a Personal Insolvency Arrangement in respect of the debtor [and, where such proposal had been received, specify the details of the proposal.]

Your petitioner therefore requests that on proof of the requisites in that behalf, on the hearing of this petition, the said debtor may be adjudged bankrupt

*[Note 5] in main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000).

*[Note 6] in secondary proceedings (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000).

*[Note 7] in territorial proceedings (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000).

YOUR PETITIONER HEREBY UNDERTAKES to this Honourable Court that, in the event of the said debtor being so adjudged your petitioner will advertise notice of the adjudication in the manner directed by this Honourable Court and bear the expenses of such advertisement. Your petitioner HEREBY INDEMNIFIES the Official Assignee as to the costs, fees and expenses incurred, or to be incurred, in the event of such adjudication by the Official Assignee and allowed by the Court. Your petitioner FURTHER UNDERTAKES to lodge such sums as this Honourable Court may direct to cover such costs, fees and expenses.

Dated
(Signed)

(Signed)
Witness
(Name, address and description of witness)

Received this ..... day of ....... 20..., at the hour of ..... o'clock in the ...... noon.

Notes:

[Note 1] In the case of the petition of a liquidator in main proceedings which concerns or involves the opening of secondary insolvency proceedings in the State pursuant to Article 27 of Council Regulation (EC) No 1346/2000 (“the Insolvency Regulation”), paragraphs 1-3 above are not required to be included. In the case of the petition of a person other than the liquidator in main proceedings (i.e. a person mentioned in Article 29(b) of the Insolvency Regulation) which concerns or involves the opening of secondary insolvency proceedings in the State pursuant to Article 27 of the Insolvency Regulation, paragraphs 1-3 above must be included. In such a case only, the appropriate alternative in the request for relief referring to secondary proceedings or, as the case may be, territorial insolvency proceedings, should be included.

[Note 2] One alternative version only of paragraph 4 must be included.

Under Council Regulation (EC) No 1346/2000—

the “centre of main interests” should correspond to the place where the debtor conducts the administration of his/her interests on a regular basis and is therefore ascertainable by third parties;

“establishment” means any place of operations where the debtor carries out a non-transitory economic activity with human means and goods.

[Note 3] Where this version of paragraph 4 is appropriate to the case, paragraph 5 should be deleted and the remaining paragraphs renumbered.

[Note 4] Where paragraph 5 is required, one alternative version only of that paragraph must be included.

[Note 5] To be completed only if Council Regulation (EC) No 1346/2000 applies and the debtor’s centre of main interests is situated in the State.

[Note 6] To be completed only if Council Regulation (EC) No 1346/2000 applies, insolvency proceedings in respect of the debtor have been opened in another Member State, and the debtor has an establishment in the State.

[Note 7] To be completed only if Council Regulation (EC) No 1346/2000 applies, insolvency proceedings in respect of the debtor have been opened in another Member State, and one of the conditions in Article 3(4) of the Council Regulation is satisfied.

*Delete where inapplicable.


(The following affidavit must be filed to verify the petition, and may be endorsed on the petition).

THE HIGH COURT

BANKRUPTCY


I, the petitioner named in the within petition, make oath and say as follows:

1. The several allegations in the said petition are true.

*2. (Where insolvency proceedings are open in another EU Member State) I refer to a certified copy of the decision /a certificate of the ...... Court of ........ .appointing *me *......... of ............ as liquidator in respect of the debtor, upon which marked “A” I have signed my name prior to the swearing hereof. [I further refer to a translation of that decision/certificate into the Irish/English language certified by a person competent and qualified for the purpose, upon which marked “B” I have signed my name prior to the swearing hereof.]

Sworn, &c.

*Delete where inapplicable


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No. 12.
AFFIDAVIT OF DEBT.
In the matter of ... a Bankrupt [or as the case may be] [or if before adjudication "In the matter of a petition for adjudication of bankruptcy by ... against ...."]
I, ... of ... make oath, and say as follows:—
1. The said [name of bankrupt or debtor or insolvent deceased] was, at the date of the filing of the petition* in this matter, and still is justly and truly indebted to ... in the sum of ... for [state nature of debt].
2. The particulars of the said debt, and any bond, bill or exchange, or promissory note held for the same, are truly set forth in the schedules hereon endorsed, for which said debt, or any part thereof, I say that no manner of satisfaction or security whatsoever hath been to my knowledge or belief had or received, save as set forth in the said schedules.
[Where proof not made by creditor in person, add]:
3. I am a person in the employment of the said ... and I am duly authorised by the said ... to make this affidavit. It is within my own knowledge that the aforesaid debt was incurred for the consideration above stated, and such debt, to the best of my knowledge and belief, still remains unpaid and unsatisfied
[Where affidavit is filed with creditors petition add]:
4. The said ... has within three months before the presentation of the said petition committed an act of bankruptcy as follows—: (give details of the specific act of bankruptcy alleged).
Sworn, &c.
*Specify date of death in the case of an insolvent deceased.
PROXY, of
is hereby appointed agent and proxy for the undersigned in the above matter, and to represent and vote for the undersigned at any sitting or meeting held before the Court, or at any adjournment thereof (and should the undersigned be appointed creditor's assignee, to accept the trust thereof on his behalf).
[Signature of creditor]
[Signed] ..... Dated .....
Witness .....
FIRST SCHEDULE WITHIN REFERRED TO
PARTICULARS OF DEMAND
Referred to in the affidavit on the other side hereof.
Date ... £ ... p. ...


SECOND SCHEDULE WITHIN REFERRED TO.
Bond, bill of exchange, promissory note, or security held by creditor, and particulars of realisation, surrender or valuation of security.
Date ... £ ... p. ...


________
(Signed)
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S.I. No. 232 of 2016

No. 13

PETITION BY A DEBTOR TO BE ADJUDICATED A BANKRUPT

THE HIGH COURT

BANKRUPTCY


No.

The petition of ........ of ......... shows as follows:

[Note 1] 1. Your petitioner is unable to meet *his *her engagements with *his *her creditors, as will appear from the statement of affairs and affidavit of your petitioner filed herewith.

[Note 2] 2. Council Regulation (EC) No 1346/2000 applies to the proceedings. Your petitioner’s centre of main interests (determined in accordance with Council Regulation (EC) No 1346/2000) is situated in the State because (state facts and grounds relied on).

2. Council Regulation (EC) No 1346/2000 applies to the proceedings. Your petitioner’s centre of main interests is situated within the territory of a Member State of the European Union in which Council Regulation (EC) No 1346/2000 applies (other than the State), namely at ...... in ......... because (state facts and grounds relied on) and your petitioner has an establishment within the State at ........ because (state facts and grounds relied on).

2. Council Regulation (EC) No 1346/2000 does not apply to the proceedings because (state facts and grounds relied on), and your petitioner is domiciled in the State (or specify which of the alternative requirements of Section 11(1)(d) of the Bankruptcy Act 1988 is fulfilled).

[Note 3] 3. Insolvency proceedings, which are

*main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000)

*secondary proceedings, (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000)

*territorial proceedings, (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000)

have been opened in respect of your petitioner in a Member State of the European Union to which Council Regulation (EC) No 1346/2000 applies (other than the State), namely in ........., by decision of ........ made on ....... 20.... ...... of ...... was appointed by the said decision to be liquidator (within the meaning of Article 2(b) of Council Regulation (EC) No 1346/2000) in those proceedings concerning your petitioner.

*4. (Where territorial proceedings are sought and no main proceedings are open in another EU Member State) The centre of your petitioner’s main interests is situated within the territory of a Member State other than the State, and main proceedings have not been opened in another Member State. The condition referred to in *[Article 3(4)(a)] *[Article 3(4)(b)] of the Insolvency Regulation is met because (state facts and grounds relied on, e.g. main proceedings cannot be opened in respect of the debtor where the centre of the debtor’s main interests is situated, because of the conditions laid down by the law of that State).

Your petitioner therefore requests that your petitioner may be adjudged bankrupt

*[Note 4] in main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000).

*[Note 5] in secondary proceedings (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000).

*[Note 6] in territorial proceedings (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000).

YOUR PETITIONER HEREBY UNDERTAKES to this Honourable Court that, in the event of *his *her being so adjudged, your petitioner will advertise notice of the adjudication in the manner directed by this Honourable Court and bear the expenses of such advertisement. Your petitioner HEREBY INDEMNIFIES the Official Assignee as to the costs, fees and expenses incurred or to be incurred, in the event of such adjudication, by the Official Assignee and allowed by the Court. Your petitioner FURTHER UNDERTAKES to lodge such sums as this Honourable Court may direct to cover such costs, fees and expenses.

Notes:

[Note 1] In any appropriate case, one of the following statements may be substituted, where applicable, for the statement at paragraph 1:

1. Your petitioner has been subject as a debtor to a Debt Settlement Arrangement which has been terminated under section 83 of the Personal Insolvency Act 2012.

1. Your petitioner has been subject as a debtor to a Debt Settlement Arrangement which under section 84 of the Personal Insolvency Act 2012 is deemed to have failed.

1. Your petitioner has been subject as a debtor to a Personal Insolvency Arrangement which has been terminated under section 122 of the Personal Insolvency Act 2012.

1. Your petitioner has been subject as a debtor to a Personal Insolvency Arrangement which under section 123 of the Personal Insolvency Act 2012 is deemed to have failed.

[Note 2] One alternative version only of paragraph 2 must be included.

Under Council Regulation (EC) No 1346/2000—

the “centre of main interests” should correspond to the place where the debtor conducts the administration of his/her interests on a regular basis and is therefore ascertainable by third parties;

“establishment” means any place of operations where the debtor carries out a non-transitory economic activity with human means and goods.

[Note 3] Paragraph 3 must be included: (a) in any case in which main insolvency proceedings have been opened in another Member State and the debtor’s petition concerns or involves the opening of secondary insolvency proceedings (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000) in the State pursuant to Article 27 of the Insolvency Regulation (by virtue of Article 29(b) of the Insolvency Regulation), or (b) in any case in which territorial insolvency proceedings (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000) have been opened in another Member State. In such a case only, the appropriate alternative in the request for relief referring to secondary proceedings or, as the case may be, territorial insolvency proceedings, should be included.

[Note 4] To be completed only if Council Regulation (EC) No 1346/2000 applies and the petitioner’s centre of main interests is situated in the State.

[Note 5] To be completed only if Council Regulation (EC) No 1346/2000 applies, insolvency proceedings in respect of the petitioner have been opened in another Member State, and the petitioner has an establishment in the State.

[Note 6] To be completed only if Council Regulation (EC) No 1346/2000 applies, insolvency proceedings in respect of the petitioner have been opened in another Member State, and one of the conditions in Article 3(4) of the Council Regulation is satisfied.

*Delete where inapplicable

Dated
Signed

(Signed)
Witness
(name, address and description of witness)

Received this ..... day of ...... 20..., at the hour of ...... o'clock in the ...... noon.

(The petition must be accompanied by a statement of affairs in Form 23. The following affidavit must be filed to verify the petition, and may be endorsed on the petition).


THE HIGH COURT

BANKRUPTCY


I, ........ of ......, the petitioner named in the within petition, make oath and say as follows:

1. The petition contains a full and fair description of me as to my name, trade or profession and last and usual place of abode.

*2. (Where insolvency proceedings are open in another EU Member State) I refer to a certified copy of the decision /a certificate of the ...... Court of .......... appointing ........ of ....... as liquidator in respect of me upon which marked “A” I have signed my name prior to the swearing hereof. [I further refer to a translation of that decision/certificate into the Irish/English language certified by a person competent and qualified for the purpose, upon which marked “B” I have signed my name prior to the swearing hereof.]

3. I have, prior to presenting the petition, made reasonable efforts to reach an appropriate arrangement with my creditors relating to my debts by making a proposal for a *Debt Settlement Arrangement *Personal Insolvency Arrangement, to the extent that my circumstances would permit me to enter into such an arrangement. [give details of proposal.]

4. The remaining allegations of fact in the said petition are true.

Sworn, &c.

*Delete where inapplicable


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No. 14.
SUMMONS TO BANKRUPT TO ATTEND PUBLIC SITTINGS
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
To ....... [the bankrupt].
You are hereby required personally to be and appear before the Court, at the Four Courts, Dublin, at the statutory sitting of the Court, to be examined, and to make a full disclosure of your property. The statutory sitting will be held on ... the ... day of ... 19 ..., at the hour of ... o'clock in the ... noon.
Herein fail not at your peril.
Given under the seal of the Court at Dublin, this ... day of ... 19 ... .
[See notice on back hereof].
[ The following notice is to be endorsed on the back of the notice]:
1. It is the duty of the bankrupt to deliver to the Official Assignee, Four Courts, Dublin, lists of all his creditors and all his debtors as soon as possible.
2. The statement of affairs of the bankrupt, verified upon oath in the prescribed form is to be lodged with the Official Assignee not later than two clear days before the statutory sitting mentioned in the summons on the other side and a duplicate of same thereupon delivered to the Central Office and a true copy filed in the proper office.
3. It is the duty of the bankrupt to apply himself at once to the preparation of his statement of affairs in order that the same may be filed as above directed.
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S.I. No. 461 of 2013

No. 15

ORDER OF ADJUDICATION

THE HIGH COURT

BANKRUPTCY


Before Mr./Ms. Justice

In the matter of a petition of bankruptcy by .................

*[in the case of a petition by a person other than the debtor] against .................

Upon the hearing of the said petition this day, and proof satisfactory having been given:

*[in the case of a creditor’s petition for adjudication by a person other than the liquidator in main proceedings]

that the requirements of section 11(1) of the Bankruptcy Act 1988 have been complied with

*or [in the case of a debtor's petition for adjudication] that the petitioner is, unable to meet *his *her engagements with *his *her creditors

And the Court having considered in accordance with section *14(2) *15(2) of the Bankruptcy Act 1988 the nature and value of the assets available to the debtor, the extent of *his *her liabilities, and whether the debtor’s inability to meet *his *her engagements could, having regard to those matters and the contents of the statement of affairs of the debtor filed with the Court, be more appropriately dealt with by means of a *Debt Settlement Arrangement *Personal Insolvency Arrangement, *and the Court having adjourned the hearing of the petition to allow the debtor an opportunity to enter into such arrangement

†And the Court being satisfied that the centre of main interests of the said ................. is situated in Ireland, IT IS ORDERED that the said ................. be and *he *she is hereby adjudged bankrupt in main proceedings, in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000

†And the Court being satisfied that proceedings have been opened in another Member State as proceedings to which Article 3(1) of Council Regulation (EC) No 1346/2000 refers, IT IS ORDERED that the said ................. be and *he *she is hereby adjudged bankrupt in secondary proceedings, in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000

†And the Court being satisfied that the centre of main interests of the said ............ is not situated in Ireland, but that an establishment of the said ................. is situated in Ireland, IT IS ORDERED that the said ................. be and *he *she is hereby adjudged bankrupt in territorial proceedings, in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000

†And the Court being satisfied that Council Regulation (EC) No 1346/2000 does not apply to these proceedings, IT IS ORDERED that the said ................. be and *he *she is hereby adjudged bankrupt

Given under the seal of the Court this ....... day of .........., 20....

Judge

Solicitor for the petitioner

[address]

[In the case of a petition by a person other than the debtor, the following notice is to be endorsed on the order]

Notice: The time allowed for showing cause to the Court against the validity of this order of adjudication is three days from the service of this copy thereof upon the bankrupt, unless the Court shall think fit to extend such time in accordance with Section 16 of the Bankruptcy Act 1988.

† Only one alternative version must be used.

*Delete where inapplicable


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No. 16.
NOTICE BY DEBTOR TO SHOW CAUSE AGAINST THE VALIDITY OF ADJUDICATION
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
Notice is hereby given that the said ... intends to show cause to the Court against the validity of the adjudication of bankruptcy made on the ... day of ... 19 ... , against him,on the grounds that the following requirement(s) of Section 11 (1) of the Bankruptcy Act, 1988, have not been complied with:—
An affidavit setting out in detail the grounds of the application to show cause has been filed and is served herewith.
Solicitor for
[address]
[The back of this notice shall be endorsed as follows]:
THE HIGH COURT.
BANKRUPTCY.
No. ...
In the matter of ... a Bankrupt.
NOTICE OF INTENTION TO SHOW CAUSE AGAINST THE ADJUDICATION.
... day the ... day of ... 19 ..., at the hour of ... o'clock in the ... noon, has been appointed for the hearing before the Court of the cause against the adjudication on the within notice.
Dated
(Signed)
Examiner.
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No. 17.
NOTICE OF APPOINTMENT OF SOLICITOR
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
[or as the case may be]
Take notice that I have been appointed solicitor for [state name and address of party represented, and that party's standing in the matter, e.g. bankrupt, creditor &c].
Signed
Solicitor.
The registered place of business of ... is:
To the Examiner,
Four Courts,
Dublin 7.
and: [specify other parties to be served]
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No. 18.
NOTICE OF CHANGE OF SOLICITOR
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
[or as the case may be]
Take notice that I have been appointed solicitor for [state name and address of party represented, and that party's standing in the matter e.g. bankrupt, creditor, &c.], in place of [state name and address of solicitor previously representing the party].
Signed
Solicitor
The registered place of business of ... is:
To the Examiner
Four Courts.
Dublin 7.
and:
[specify other parties to be served]
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S. I. No. 232 of 2016

No. 19

NOTICE OF ADJUDICATION

THE HIGH COURT

BANKRUPTCY


No.

In the matter of ........ a Bankrupt

........ of ......... was on the ...... day of ......... 20..., adjudged Bankrupt

*in main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000).

*in secondary proceedings, (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000).

*in territorial proceedings, (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000).

*the Court having determined that Council Regulation (EC) No 1346/2000 does not apply to the proceedings.

The Bankrupt is required to make full disclosure of his property to the Court. Creditors may prove their debts and choose and appoint a creditors’ assignee. All persons having in their possession or under their control any money or other property of the Bankrupt should pay or deliver the same, and all debts due to the Bankrupt should be paid to ....... Official Assignee, of ......, to whom creditors may forward their proofs of debt.

Dated
(Signed) ..........
Examiner

Solicitor
[address]

*delete where inapplicable


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No. 20.
NOTICE OF SITTING FOR DISTRIBUTION OF ESTATE AND OF FILING OF DOCUMENTS
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... of ... a Bankrupt.
[or as the case may be]
A sitting of the Court will be held at the Four Courts, Dublin 7, on the ... day of ... 19 ... , at the hour of ... o'clock in the ... noon, for the purposes of a final [or an interim] distribution of the estate of the above-named, the documents required by statute having been filed by me in the matter.
Dated
(Signed)
Official Assignee,
Four Courts,
Dublin 7.
Solicitor for the Official Assignee
[address]
To [Name and address of creditor to be served]
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No. 21.
NOTICE TO CREDITORS TO PROVE DEBTS
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
[or as the case may be]
The above-named was on the ... day of ... 19 ... adjudged bankrupt.
All persons claiming to be creditors in this matter are to send their proofs of debt to me at the Four Courts, Dublin 7, on or before the ... day of ... 19 ....
Dated
(Signed)
Official Assignee,
Four Courts,
Dublin 7.
Solicitor for the Official Assignee.
[address]
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S.I. No. 120 of 2012

No. 21A

THE HIGH COURT
BANKRUPTCY

Invitation to lodge a claim
No.
In the matter of ................. a Bankrupt

Покана за предявяване на вземане. Срокове, които трябва да се спазват
Convocatoria para la presentación de créditos. Plazos aplicables 
Výzva k přihlášení pohledávky. Závazné lhůty 
Opfordring til anmeldelse af fordringer. Vær opmærksom på fristerne
Aufforderung zur Anmeldung einer Forderung. Etwaige Fristen beachten!
Nõude esitamise kutse. Järgitavad tähtajad
Προ΄σκληση για αναγγελι΄α απαιτη΄σεως. Προσοχη΄ στις προθεσμι΄ες
Invitation to lodge a claim. Time limits to be observed
Invitation à produire une créance. Délais à respecter
Cuireadh chun éileamh a thaisceadh. Teorainn ama socraithe
Invito all’insinuazione di un credito. Termine da osservare
Uzaicinājums iesniegt prasījumu. Termiņi, kas jāievēro
Kvietimas pateikti reikalavimą. Privalomieji terminai
Felhívás követelés bejelentésére. Betartandó határidők
Stedina għal preżentazzjoni ta' talba
Oproep tot indiening van schuldvorderingen. In acht te nemen termijnen
Wezwanie do zgłoszenia wierzytelności. Przestrzegać terminów
Aviso de reclamação de créditos. Prazos legais a observar
Invitație de înregistrare a cererii de admitere a creanței. Termenul limită
Výzva na prihlásenie pohľadávky. Je potrebné dodržať stanovené termíny
Poziv k prijavi terjatve. Roki, ki jih je treba upoštevati!
Kehotus saatavan ilmoittamiseen. Noudatettavat määräajat
Anmodan att anmäla fordran. Tidsfrister att iaktta
To: ...................
of ....................
............... of ............ (“the bankrupt”) was on the .... day of ........ 20 ..., adjudged bankrupt by the High Court. *The undersigned is the liquidator in main proceedings of the bankrupt for the purposes of the Insolvency Regulation.
You have been entered in the bankrupt's statement of affairs or have otherwise come to my notice as a creditor of the bankrupt, who has not yet lodged a claim or proof of debt with me.
Please take notice of the following:
1. Claims and proofs of debt in respect of the bankrupt, bearing the heading “Lodgement of claim” and record number ......., and including the documents and information set out in Article 41 of Council Regulation (EC) No 1346/2000 and in accordance with the requirements of the First Schedule to the Bankruptcy Act 1988 (the text of which is attached), must be submitted to me at the address below no later than the .......... day of ........ 20 ..... If the claim or proof of debt is not in English or Irish, you must also provide a translation of same into English or Irish.
2. A proof submitted after that date shall not be allowed except by order of the High Court.
3. Creditors whose claims are preferential or secured in rem must lodge their claims with me within the period and in the form set out above.
4. Claims and proofs should be sent by registered post to: Official Assignee, Phoenix House, 15/24 Phoenix Street North, Smithfield, Dublin 7, Ireland (or as appropriate for trustee).
[A copy of the provisions of the First Schedule to the Bankruptcy Act 1988 to be attached.]
*Delete where inapplicable.
_______


No. 22.
PROXY
THE HIGH COURT
BANKRUPTCY
In the matter of ... a Bankrupt.
[or as the case may ]
of
is hereby appointed agent and proxy for the undersigned in the above matter, and to represent and vote for the undersigned at any sitting of or meeting held before the Court, or at any adjournment thereof (and should the undersigned be appointed creditors' assignee, to accept the trust thereof on his behalf).
[Signature of creditor]
Dated.
[Signed]
Witness.
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S.I. No. 461 of 2013

No. 23

THE HIGH COURT

BANKRUPTCY


Office Reference No: .................

Statement of Affairs of

................. (Name)


Address: .................

The date of Adjudication ..... /.... /.....


________

Previous Bankruptcies/Arrangements (if any)


*I was a bankrupt in the year ...............

*I presented a Petition for Arrangement in the year ............ And effected an arrangement of ............... in the Euro Debts amounting to €...............

*Delete if not applicable

Signed: .................

(Please note that all pages must be signed by person swearing this affidavit.)


Summary of Statement of Affairs

(Please insert total sums in relation to each heading)

Part 1: Assets

AMoveable PropertyPage....
i) CashPage....
ii) Accounts with Financial Institutions which show a balance to creditPage....
iii) InvestmentsPage....
iv) Debts due to youPage....
v) Other AssetsPage....
BImmoveable PropertyPage....

Part 2: Liabilities

i) Unsecured CreditorsPage....
ii) Secured CreditorsPage....


Part 3: General

i) IncomePage....
ii) Property in Expectancy Yes/NoPage....
iii) Accounts, Papers, Deeds, Etc. Yes/NoPage....


Part 4: Declaration

Signed: .................



PART 1 — LIST OF ASSETS

A — MOVEABLE PROPERTY i.e. all assets other than land or buildings


i) Cash

State amount of cash in your possession

Total amount of cash in Hand €.................

ii) Accounts with Financial Institution

Give details of any sums held by you in Financial Institution accounts, including account number and branch where account held (overdrawn accounts should not be shown here but should be shown under unsecured creditors at page ....... below):-

No.Name of Financial InstitutionBranchA/C NumberBalance (€)
FI1
FI2
FI3
FI4
FI5
FI6
FI7
FI8
FI9
FI10
FI11
FI12
FI13
FI14
FI15
FI16
Total amount in Financial Institution

Signed: .................

iii) Investments

Give details of any investments you have, i.e. stocks, shares, bonds, savings certificates, endowment insurance, pension, life policies, etc.

No.Type of InvestmentName and address of Company or InstitutionRef. No.Current Estimated Value
INV1
INV2
INV3
INV4
INV5
INV6

Give details of any company (registered with Company’s Registration Office) in which you have had a management role in the last five years

No.Name and address of Company% ShareholdingCRO. No.Current Estimated Value of your interest allowing for dividend distributions, Directors Loans to and from company etc.
SH1
SH2
SH3

iv) Debts due to you

Give details of any debts owed to you, stating the name and address of the person or body by whom the debt is owed.

No.Name and address of DebtorNature of DebtAmount due (€)Disputed Y/N
D1
D2
D3
D4
D5
D6
D7
D8
D9

Signed: .................

v) Other Assets (Other than land or Buildings)

List any other property owned by you or in the course of purchase under credit, e.g. motor vehicles, goodwill of a business, electrical goods, jewellery, antiques, livestock, machinery.

No.Full Description of AssetState whether items subject to hire purchase or other credit agreement — YES/NOEstimated Current
Value
OTH1
OTH2
OTH3
OTH4
OTH5
OTH6
OTH7
OTH8
OTH9
OTH10
OTH11
OTH12
OTH13
OTH14
OTH15
OTH16
OTH17
OTH18
OTH19
OTH20
OTH21
OTH22
OTH23
OTH24
OTH25

Signed: .................


B — IMMOVEABLE PROPERTY (Land, houses, buildings etc.)

List all the buildings/land in which you have an interest as owner or tenant.

No.Type of Property and Folio NumberAddressNature of Interest e.g. Tenant or Owner or Joint OwnerEstimated Current ValueMortgage Amount owingEstimated current value of your interest
LB1
LB2
LB3
LB4
LB5
LB6
LB7
LB8
LB9
LB10
LB11
LB12

Signed: .................


PART 2 — LIST OF CREDITORS

UC — Unsecured Creditors (specify unsecured debts due by you)


Unsecured creditors (These do not include a mortgage (including judgment mortgage), charge or lien created in respect of liability e.g. personal bills, loans or overdrafts, creditor invoices and liabilities in respect of personal guarantees etc.)

No.Name and address of CreditorEmail AddressDescription of DebtAccount No. (if any)Amount Due €Accepted or Disputed
UC1
UC2
UC3
UC4
UC5
UC6
UC7
UC8
UC9
UC10
UC11
UC12
UC13
UC14
UC15
UC16
UC17
UC18
UC19
UC20
UC21
UC22
UC23
UC24
Total amount of unsecured creditors

Signed: .................


SC-Secured Creditors (Specify debts due by you which have been secured against assets.)

Secured Creditors (a secured creditor is a creditor who can repossess and sell your assets if you fall behind with your payments. For example a mortgage or charge over your house, a hire purchase or lease agreement over your vehicle or a bill of sale over your non-company business assets)

No.Name and address of Financial InstitutionSpecify whether a mortgage / hire purchase / lease agreement and provide the account numberAmount Due €Details of relevant property including the folio number
SC1
SC2
SC3
SC4
SC5
SC6
SC7
SC8
SC9
SC10
SC11
SC12
SC13
SC14
SC15
SC16
SC17
SC18
SC19
SC20
SC21
SC22
SC23
SC24
SC25
SC26
Total amount of secured creditors

Signed: .................


PART 3 — GENERAL

i) Income

Average monthly take home pay net of taxation (including overtime, commission, bonus etc.)
Other income e.g. pensions, income bonds, benefits etc. (please specify)
Total Income INC01
Total Set Costs (Reasonable Living Expenses based on household composition)
Total Other Costs
(Mortgage/Rent,
Childcare,
Special Circumstances)



ii) Property in Expectancy

No.Description of PropertyTestator / Settlor Name and AddressBy Will / Intestate Succession or Trust
E1
E2
E3
E4
E5
E6
E7

iii) Accounts, Papers, Deeds, Electronic Records and other documents relating to my estate

No.DescriptionIn whose possession and where to be found
1
2
3
4
5
6

Signed: .................


PART 4 — DECLARATION

I, the said ................. make oath and say:

I have carefully read the foregoing statement of my affairs, on each page of which I have signed my name.

* My debts exceed my assets by the sum of € ..... *My assets exceed my debts by the sum of € .....

I say that the same contains a full and true account of all debts due by me; that the same are justly due by me, save as therein otherwise stated; and that I am not, to my knowledge, indebted to any person or persons except the creditors therein named.

I say that the said statement contains a full and true account of all debts due to me and that there are not to my knowledge or belief any debts due to me except the debts therein returned.

I say that the said statement contains a full and true account and description of all other property of any kind or description whatsoever of which I am possessed or to which I am entitled.

Sworn at

In the County of .................

This ....... day of ............ Two Thousand and ........

before me a Commissioner for Oaths [or as the case may be] and I know the Deponent

Signed .................

.................

.................

Commissioner for Oaths

[or as the case may be]

Signed

Solicitor for the debtor

Note

It is the duty of the bankrupt to prepare his statement of affairs in this form and to be accurate in making the statements for which the several columns are intended. Particular attention is required as to dates and amounts.

*Insert as appropriate. Note that a debtor may not present a petition for adjudication unless the debts of the debtor exceed the assets of the debtor by an amount greater than €20,000. (section 11(5), Bankruptcy Act 1988)


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S.I. No. 461 of 2013

No. 24

COMPOSITION AFTER BANKRUPTCY — NOTICE OF MEETING OF CREDITORS

THE HIGH COURT

BANKRUPTCY


No.

In the matter of ................. of ................. a Bankrupt.

A meeting will be held before the Court at the Four Courts, Dublin 7, on ..... the ..... day of ............ 20....., at the hour of ..... o’clock in the ........... noon, to consider the offer of the Bankrupt to pay the sum of ....... cent in the euro by way of a composition on *his *her debts. If three-fifths in number and value of the creditors voting at the meeting, either in person or by an agent authorised in writing in that behalf, accept the offer or any modification of it, it shall be deemed to be accepted, and when approved by the Court shall be binding on all creditors of the Bankrupt. A creditor whose debt is less than €500 shall not be entitled to vote. Debts may be proved at the meeting. Creditors who have not yet sent proofs of their debts to the Official Assignee at the Insolvency Service, ................., Dublin.., should do so forthwith.

Creditors are entitled to obtain from the Bankrupt, free of charge, a copy of his statement of affairs. Copies of the statement of affairs may be obtained from [state name and address of Bankrupt's solicitor, or of Bankrupt if no solicitor is employed].

Dated this ...... day of ................. 20.....

(Signed) Examiner.

Solicitor for Bankrupt

(address)

*delete where inapplicable


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No. 25.
COMPOSITION AFTER BANKRUPTCY — REPORT OF OFFICIAL ASSIGNEE
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt
Upon inquiry held by me pursuant to Order 76, rule 88, of the Rules of the Superior Courts, I find and report as follows:—
On the ... day of ... 19 ..., a meeting of creditors was held in this matter for the purpose of deciding upon the offer of composition made by the Bankrupt.
At such meeting three-fifths in number and value of the creditors computed according to the statute agreed to accept the offer, which was in the words following:—
[set out offer]
I find and report that the composition so agreed to be accepted has been paid to all the creditors entitled thereto, or has been lodged with the Official Assignee for such of the creditors as cannot be found, or who may have declined to receive the same.
I further find that all costs ordered by the Court and all preferential debts have been paid or satisfied.
Dated
(Signed)
Official Assignee
__________
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No. 31
CONSENTING OR UNDERTAKING OF SURETY
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt
an Arranging Debtor
[as the case may be]
Whereas the said ... of ... has with the leave of the Court made an offer of composition to his creditors (or has petitioned the Court praying that such proposal as he might be able to make to his creditors for the future payment or compromise of his debts or engagements, and which should be agreed to by them, might be executed under the direction of the Court).
And where an offer of composition (or a proposal) has accordingly been made in the words and figures following, that is to say [set out].
Now I, ... of ... named in the foregoing offer of composition (or proposal), do hereby accept and consent thereto so far as the same relates to me; and I do hereby, in consideration of the said offer of composition
(or proposal) being agreed to by the creditors of the said ... undertake to fulfill and
perform the same, so far as the same relates to any matter or thing therein expressed to be done or performed by me as a surety; and I undertake to do all acts in that behalf which shall be directed by the Court, and lastly, I consent and agree that this consent shall be filed and made a rule of Court.
Dated
(Signature of surety)
I hereby certify that the proposed surety, who signs in my presence, has been identified to my satisfaction.
(Signed)
Official Assignee.
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S.I. No. 232 of 2016

No. 32

NOTICE OF APPOINTMENT OF TRUSTEE IN BANKRUPTCY

THE HIGH COURT

BANKRUPTCY


...... of ......... was on the ... day of... 20... adjudged bankrupt.

At a meeting of the creditors held at ..... on the ... day of ..... 20..., it was resolved by the requisite majority in number and value of the creditors that the estate of the said ....... be wound up by a trustee and committee of inspection, ...... of ......, being appointed trustee for that purpose, and the Court on application made to it in that behalf under section 110 of the Bankruptcy Act 1988 on the .... day of ..... 20.... ordered that the property of the bankrupt be so wound up.

All persons having in their possession or control any money or other property of the Bankrupt should pay or deliver the same, and all debts due to the Bankrupt should be paid, to the said ....... at his address aforementioned, to whom creditors may forward their proofs of debt.

(Signed)
Solicitors for the Trustee


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S. I. No. 120 of 2012

No. 33

PETITION FOR AN ORDER FOR THE ADMINISTRATION OF THE

ESTATE OF AN INSOLVENT DECEASED

THE HIGH COURT

BANKRUPTCY


No.

In the matter of a petition for an order for the administration in bankruptcy of the estate of ..........., deceased.

I, ........... of ........... hereby petition the Court for an order for the administration in bankruptcy of the estate of the late ............ who died on the ...... day of ............ 20....

[Note 1] 1. The estate of ........ (hereafter in this petition, “the deceased”) is justly and truly indebted to me in the sum of € ......... (state amount due and the consideration).

2. I do not nor does any person on my behalf hold any mortgage, charge or lien on the deceased's estate or any part thereof as security for the debt or any part thereof (or your petitioner holds security for the payment of (or part of) the said sum, but he will give up such security for the benefit of the creditors of the deceased in the event of an order being made for the administration of the deceased's estate in bankruptcy or your petitioner holds security for the payment of (or part of) the said sum and he estimates the value of such security at the sum of € ........ or I am the Legal Personal Representative of the said deceased).

3. The estate of the said deceased is according to my information and belief insufficient to pay his debts.

4. The will of the said deceased was on the ......... day of ......... 20 .........., proved by ........... or Letters of administration intestate [or with will annexed] of the estate of the deceased, were on the ...... day of ........... 20 ...., granted to ............... of ................

5. No proceedings have been commenced in the Circuit Court for the administration of the deceased's estate.

[Note 2] 6. (Where centre of main interests in the State) Council Regulation (EC) No 1346/2000 applies to these proceedings. The centre of main interests (determined in accordance with Council Regulation (EC) No 1346/2000) of the said deceased at the time of death was situated in the State because (state facts and grounds relied on).

[Note 2] 6. (Where centre of main interests in another EU Member State) Council Regulation (EC) No 1346/2000 applies to these proceedings. The centre of main interests (determined in accordance with Council Regulation (EC) No 1346/2000) of the said deceased at the time of death was situated within the territory of a Member State of the European Union in which Council Regulation (EC) No 1346/2000 applies (other than the State), namely at ............ in ............. because (state facts and grounds relied on) and the said deceased had at that time an establishment within the State at ...... because (state facts and grounds relied on).

[Note 3] 6. Council Regulation (EC) No 1346/2000 does not apply to the proceedings, and the deceased for the ......... months preceding his death resided or carried on business at ......... (or specify how the requirements of Section 115 of the Bankruptcy Act 1988 are fulfilled).

[Note 4] 7. (Where insolvency proceedings are open in another EU Member State) Insolvency proceedings, which are

*main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000)

*secondary proceedings, (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000)

*territorial proceedings, (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000)

have been opened in respect of the said deceased in a Member State of the European Union to which Council Regulation (EC) No 1346/2000 applies (other than the State), namely in ..........., by decision of ............ made on .......... 20 .... *[Your petitioner] *[AB of ................] was appointed by the said decision to be liquidator (within the meaning of Article 2(b) of Council Regulation (EC) No 1346/2000) in those proceedings concerning the deceased.

7. (Where no insolvency proceedings are open in another EU Member State)To your petitioner’s knowledge, no insolvency proceedings have been opened in respect of the said deceased in a Member State of the European Union to which Council Regulation (EC) No 1346/2000 applies.

*8. (Where territorial proceedings are sought and no main proceedings are open in another EU Member State) In your petitioner’s belief, the centre of main interests of the said deceased, at the time of death, was situated within the territory of a Member State other than the State, and main proceedings have not been opened in another Member State. The condition referred to in *[Article 3(4)(a)] *[Article 3(4)(b)] of the Insolvency Regulation is met because (state facts and grounds relied on, e.g. main proceedings cannot be opened in respect of the deceased where the centre of the deceased’s main interests was situated at the time of death, because of the conditions laid down by the law of that State, or the opening of territorial insolvency proceedings is requested by a creditor who has his domicile, habitual residence or registered office in the State or whose claim arises from the operation of that establishment).

Your petitioner therefore prays that on proof of the requisites in that behalf, on the hearing of this petition, the estate of the said ......... may be administered in bankruptcy

*[Note 5] in main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000)

*[Note 6] in secondary proceedings (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000)

*[Note 7] in territorial proceedings (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000).

YOUR PETITIONER HEREBY UNDERTAKES to this Honourable Court that in the event of an Order being made to administer the said estate in bankruptcy your petitioner will advertise notice of the adjudication and statutory sitting in the manner directed by this Honourable Court and bear the expenses of such advertisement. Your petitioner HEREBY INDEMNIFIES the Official Assignee as to the costs, fees and expenses incurred or to be incurred in such administration in bankruptcy by the Official Assignee and allowed by the Court. Your petitioner FURTHER UNDERTAKES to lodge such sums as this Honourable Court may direct to cover such costs, fees and expenses.

Dated this ....... day of ....... 20 ........

(Signed) ................

Signed by the petitioner in my presence

Signature of witness ..............

Address .................

Description ..................


Indorsement

This petition having been presented to the Court on the ...... day of .......... 20 ..., it is ordered that this petition be heard at the High Court, Bankruptcy, Four Courts, Dublin 7, on the ...... day of ......... 20..., at the hour of .... 'clock in the ..... noon.

If you, the said ......... intend to show cause against the petition you must file in the Examiner’s Office, Phoenix House, 15/24 Phoenix Street North, Smithfield, Dublin 7, a notice specifying the statements on the petition which you intend to dispute.

(Signed) ...............

Examiner

Notes:

[Note 1] In the case of the petition of a liquidator in main proceedings of the deceased debtor which concerns or involves the opening of secondary insolvency proceedings in the State pursuant to Article 27 of the Insolvency Regulation, paragraphs 1-3 above are not required to be included.

In the case of the petition of a person other than the liquidator in main proceedings of a deceased debtor (i.e. a person mentioned in Article 29(b) of the Insolvency Regulation) which concerns or involves the opening of secondary insolvency proceedings in the State pursuant to Article 27 of the Insolvency Regulation, paragraphs 1-3 above must be included. In such cases only, the appropriate alternative in the prayer for relief referring to secondary proceedings or, as the case may be, territorial insolvency proceedings, should be included.

Under Council Regulation (EC) No 1346/2000—

the “centre of main interests” should correspond to the place where the debtor conducts the administration of his interests on a regular basis and is therefore ascertainable by third parties;

“establishment” means any place of operations where the debtor carries out a non-transitory economic activity with human means and goods.

[Note 2] One alternative version only of paragraph 6 must be included.

[Note 3] Where this version of paragraph 6 is appropriate to the case, paragraphs 7 and 8 should be deleted and any remaining paragraphs renumbered.

[Note 4] Where paragraph 7 is required, one alternative version only must be included.

[Note 5] To be completed only if Council Regulation (EC) No 1346/2000 applies and the deceased’s centre of main interests was situated in the State.

[Note 6] To be completed only if Council Regulation (EC) No 1346/2000 applies, insolvency proceedings in respect of the deceased have been opened in another Member State, and the deceased had an establishment in the State.

[Note 7] To be completed only if Council Regulation (EC) No 1346/2000 applies, insolvency proceedings in respect of the deceased have been opened in another Member State, and one of the conditions in Article 3(4) of the Council Regulation is satisfied.

*Delete where inapplicable


(The following affidavit must be filed to verify the petition, and may be endorsed on the petition).

THE HIGH COURT

BANKRUPTCY


I, the petitioner named in the within petition, make oath and say as follows:

1. Each of the allegations of fact in the said petition is true.

*2. (Where insolvency proceedings are open in another EU Member State) I beg to refer to a certified copy of the decision /a certificate of the ...... Court of ........... appointing .............. of ........... as liquidator in insolvency proceedings in respect of the deceased, .........., upon which marked “A” I have signed my name prior to the swearing hereof. [I further beg to refer to a translation of that decision/certificate into the Irish/English language certified by a person competent and qualified for the purpose, upon which marked “B” I have signed my name prior to the swearing hereof.]

Sworn, &c.

*Delete where inapplicable.


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S.I. No. 232 of 2016

No. 34

NOTICE OF ORDER FOR ADMINISTRATION OF ESTATE OF DECEASED INSOLVENT

THE HIGH COURT

BANKRUPTCY


No.

In the matter of ......... Insolvent Deceased

An order was made on the ..... day of ...... 20.... for the administration in bankruptcy of the estate of the above named deceased

*in main proceedings, (in accordance with Article 3(1) of Council Regulation (EC) No 1346/2000).

*in secondary proceedings, (in accordance with Article 3(3) of Council Regulation (EC) No 1346/2000).

*in territorial proceedings, (in accordance with Article 3(4) of Council Regulation (EC) No 1346/2000).

*the Court having determined that Council Regulation (EC) No 1346/2000 does not apply to the proceedings.

Creditors may prove their debts and choose and appoint a creditors’ assignee. All persons having in their possession or under their control any money or other property of the deceased’s estate should pay or deliver the same, and all debts due to the deceased’s estate should be paid to ........ Official Assignee, of ......, to whom creditors may forward their proofs of debt.

Dated
(Signed) ........
Examiner

Solicitor
[address]

*delete where inapplicable


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S.I. No. 232 of 2016

No. 34A

CERTIFICATE UNDER SECTION 85(3G) OF THE BANKRUPTCY ACT 1988

THE HIGH COURT

BANKRUPTCY


No.

I hereby certify pursuant to section 85(3G) of the Bankruptcy Act 1988 that ALL THAT AND THOSE the estate, right, title and interest of ......., of ........ in [give short description of property indicating whether the same is a freehold or leasehold interest and whether registered or unregistered and, where registered, specifying the folio number(s) concerned],which had vested in me pursuant to the provisions of the Bankruptcy Act 1988 by virtue of the adjudication of the said ....... .as a bankrupt on the ... day of ..... 20..., has re-vested in the said ...... in accordance with section 85 of the Bankruptcy Act 1988.

Dated
(Signed).............
Official Assignee

*delete where inapplicable



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S.I. No. 461 of 2013


No. 35

CONSENT OF CREDITOR TO DISCHARGE FROM BANKRUPTCY SECTION 85B, BANKRUPTCY ACT 1988.

THE HIGH COURT

BANKRUPTCY


No.

In the matter of ................. a Bankrupt.

Whereas I, ................., of ................., have been admitted as a creditor in the bankruptcy of the above-named for the sum of € ........ in respect of [state nature of debt].

I do hereby consent to the discharge of the said ................. from bankruptcy. I understand that the giving of this consent constitutes a waiver of my right to recover the amount aforementioned.

Dated

[Signed]

(Signed)

Witness


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No. 36
AFFIDAVIT OF SERVICE
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ...
1. On the ... day of ... 19 ... ,
I ... served ... of ... with ... in this matter, bearing date the ... day of ... 19 ..., hereto annexed, marked with the letter A on which I have signed my name before swearing this affidavit, by delivering unto and leaving with ... at ... in ... the ... of ... a true copy thereof, and at the same time I showed unto the said ... the said ... hereof annexed.
2. On the ... day of ... 19 ... , being within three days of such service, I endorsed upon the said ... the hour and day of the week, month and year of such service
[Where appropriate add:]
3. I say that at the time aforesaid I paid to the said ... the sum of ... to defray his expenses of attending, pursuant to the said ...
Sworn, &c.
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No. 37.
CERTIFICATE OF VESTING OF THE ESTATE AND EFFECTS
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... o ... a Bankrupt
[or as the case may be]
This is to certify that all the estate and effects, real and personal of the said ... have been vested in the Official Assignee (or, where appropriate) in ... trustee in this matter.
Given under the seal of the Court this day of .....
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No. 38.
WARRANT TO APPREHEND DEBTOR ABOUT TO ABSCOND AFTER BANKRUPTCY SUMMONS, SECTION 9 — BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
In the matter of a Bankruptcy Summons by ... against ...
To the Commissioner and members of An Garda Síochána, greeting.
Whereas a Bankruptcy Summons dated the ... day of ... 19 ..., has been granted to the said ... against the said ...
And whereas it has been made to appear to the Court that there is probable cause for believing that he is about to [leave the State] or [abscond] with a view to [avoiding payment of the debt] or [delaying proceedings in bankruptcy].
You are hereby commanded, immediately upon the receipt hereof, to arrest the said ... so as to have him before this
Court at the next available sitting, and until such sitting to lodge the said in the prison and to deliver this warrant to the Governor of such prison.
Given under the seal of the Court.
Dated
[Seal]
(Signed)
Examiner.
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S.I. No. 232 of 2016

No. 39

SUMMONS — SECTION 21, BANKRUPTCY ACT 1988

THE HIGH COURT

BANKRUPTCY


No.

To ........ of [state address];

You are hereby commanded to be and appear before the Court, at the Four Courts, Dublin, on the... day of... 20... at the hour of... o'clock in the... noon [and, where appropriate] to be examined [concerning the trade, dealings, affairs or property of the bankrupt] [and, where appropriate] [and also to bring with you and produce at the time and place aforesaid any books of account, other papers or records (including copies of such books of account, other papers or records held in electronic form) in your possession or control relating to the matters aforesaid, including in particular the following:—]


HEREIN FAIL NOT AT YOUR PERIL

GIVEN under the seal of the Court at Dublin, this .... day of ........

(Signed) ............
Examiner.


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No. 40
WARRANT TO APPREHEND BANKRUPT ABOUT TO ABSCOND — SECTION 23 (1) BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt
To the Commissioner and members of An Garda Siochana, greeting.
Whereas ... of ... in the title hereof named was by Order of the Court on the ... day of ... 19 ..., adjudged Bankrupt and whereas it has been made to appear to the Court that there is probable cause for believing that ... [is about to leave the State or otherwise to abscond] or [has removed or concealed or is about to remove or conceal any of his property] with a view to avoiding [payment of his debts] or [examination in respect of his affairs].
or
is keeping out of the way and cannot be served with a summons.
You are hereby commanded, immediately upon the receipt hereof, to arrest the said ... so as to have him before this Court at the next available sitting for examination, and until such sitting to lodge the said ... in the ... prison and to deliver this warrant to the Governor of such prison.
Given under the seal of the Court.
[Seal]
Dated
(Signed)
Examiner.
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No. 41.
WARRANT TO ARREST FOR FAILURE TO APPEAR TO SUMMONS—SECTION 23 (2) AND (3) BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
To the Commissioner and members of An Garda Siochana, greeting.
Whereas it has been proved to the satisfaction of the Court that a summons pursuant to Section 21 of the Bankruptcy Act, 1988, was on the ... day of ... 19 ..., served on ... of ... requiring his attendance before the Court [this day] or [on the ... day of ... ].
And whereas the said ... has not attended before the ... Court at the time appointed not having an excuse made known to the Court at the time of its sitting and allowed by it.
You are hereby commanded, immediately upon the receipt hereof, to arrest the said ... so as to have him before this Court at the next available sitting for examination and until such sitting to lodge the said ... in the ... prison and to deliver this warrant to the Governor of such prison.
Given under the seal of the Court this ... day ... of ...
[Seal]
(Signed)
Examiner.
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No. 42.
WARRANT OF COMMITTAL FOR REFUSING TO BE SWORN OR TO ANSWER—SECTION 24 BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt
To the Commissioner and members of An Garda Síochána, greeting.
Whereas ... of ... being present in the Court on the ... day of ... was required to submit to be duly sworn and examined, pursuant to the Statute but the said ... then and there refused to be sworn [or refused to answer the questions put to him by the Court].
You are hereby commanded, immediately upon receipt hereof, to arrest the said ... and thereupon to lodge him in ... prison and to deliver this warrant to the Governor of such prison, who is hereby commanded to keep the said ... in his custody, until he shall submit himself to the Court to be sworn, and full answers make, to the satisfaction of the Court to such questions as shall be put to him.
Given under the seal of the Court this ... day of ...
[Seal]
(Signed)
Examiner.
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No. 43.
WARRANT OF COMMITTAL FOR UNSATISFACTORY ANSWERING OR FOR REFUSING TO SIGN EXAMINATION—SECTION 24 BANKRUPTCY ACT, 1988
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt
To the Commissioner and members of An Garda Síochána, greeting.
Whereas the said ... of ... was on the ... day of ... duly sworn and examined in ... the Court, as by the examination and deposition of the said ... now on the file of proceedings in this matter will appear;
And whereas the answers of the said ... as now so appearing in the said examination and deposition, are unsatisfactory [or the said ... refused to sign and subscribe his said examination and deposition];
You are hereby commanded, immediately upon the receipt hereof, to arrest the said ... and thereupon to lodge him in ... prison and to deliver this warrant to the Governor of such prison, who is hereby commanded to keep the said ... in his custody,until the Court shall make an Order to the contrary.
Given under the seal of the Court this ... day of ...
[Seal]
(Signed)
Examiner.
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No. 44.
WARRANT OF COMMITTAL AGAINST A PERSON DISOBEYING AN ORDER OF COURT—SECTION 24 BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
To the Commissioner and members of An Garda Síochána, greeting.
Whereas by an Order of the Court, bearing date the ... day of ... it was ordered that [&c., as in the Order]:
And whereas it is now proved that on the ... day of ... a copy of the said Order was duly served on the said ... [personally] or [otherwise as allowed by the Court] but the said ... has not as yet obeyed the said Order;
You are hereby commanded, immediately upon receipt hereof, to arrest the said ... and thereupon to lodge him in ... prison and to deliver this warrant to the Governor of such prison, who is hereby commanded to keep the said ... in his custody, until the Court shall make an Order to the contrary.
Given under the seal of the Court this ... day of ...
[Seal]
(Signed)
Examiner.
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No. 45.
WARRANT TO BRING PERSON BEFORE COURT—SECTION 25 BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ... a Bankrupt.
To the Governor of the ... Prison.
Whereas ... of ... was by Order of the Court made on the ... day of ... directed to be arrested and lodged in the ... prison.
And whereas the said Order was executed on the ... day of ... by lodging the body of the said ... together with a warrant given under the seal of the Court on the ... day of ...
You are hereby commanded to produce the body of the said ... before this Court (sitting in Court No. ) to abide the Order of the Court, at ... o'clock in the ... noon of the ... day of ...
Provided always that where no Order shall hereafter be made by this Court for the release of the said ... you are hereby commanded to return the body of the said ... to the ... prison and to keep the said ... in your custody,until the Court shall make an Order to the contrary for which the said warrant given under the seal of the Court on the ... day of ... shall be sufficient authority.
Given under the seal of the Court this ... day of ...
[Seal]
(Signed)
Examiner.
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S.I. No. 461 of 2013

No. 46

WARRANT OF SEIZURE—SECTION 27 BANKRUPTCY ACT 1988

THE HIGH COURT BANKRUPTCY


No.

In the matter of ................. of ................. a Bankrupt

Whereas on the ..... day of ................. 20....., an Order of adjudication of bankruptcy was made against the said bankrupt.

These are therefore to require, authorise, and empower you, and every one of you to whom this warrant is directed, forthwith to enter into and upon any house, building, room or other place belonging to the said Bankrupt where any of *his *her property is believed to be; and there seize all property whatsoever belonging to the said bankrupt except such articles of clothing, household, furniture, bedding, tools or equipment of the Bankrupt's trade or other like necessities for the Bankrupt, the Bankrupt’s spouse or civil partner within the meaning of the Civil Partnership and Certain Rights and Obligations of Cohabitants Act

2010 and the Bankrupt’s children and dependent relatives residing with the Bankrupt as the Bankrupt may select, not exceeding in value €6,000 and all such property you shall cause to be inventoried, and such inventory you shall return to the Court with all convenient speed, and what you shall so seize you shall safely detain and keep in your possession until the Court shall give you Order for the disposal thereof; and in case of resistance, or of not having the key or keys of any door or lock belonging to any place or places as aforesaid, of the said Bankrupt where any of *his *her property is believed to be, you shall break open, or cause to be broken open the same for the better execution of this warrant.

Given under the seal of the Court this ..... day of ................. 20.......

[Seal]

Examiner.

To ................

Bankruptcy Inspector or his Assistant.


*delete where inapplicable.


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No. 47.
SEARCH WARRANT—SECTION 28 BANKRUPTCY ACT 1988.
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ...
a Bankrupt.
Whereas by evidence duly taken upon oath it hath been made to appear to the satisfaction of the Court that there is reason to believe that property of the said ... is concealed in the house [or other place, describing it, as the case may be] of ...
You are hereby authorised and required, with necessary and proper assistance to enter, in the daytime, into the said house [or other place, describing it, as the case may be], situate at ... aforesaid and there diligently to search for the said property; and if any property of the said bankrupt shall be there found by you on such search, that you seize the same, to be disposed of and dealt with according to law.
Given under the seal of the Court, this ... day of ...
[Seal]
Examiner.
To .....
Bankruptcy Inspector
or
his Assistant.
[or as the case may be]
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S.I. No. 461 of 2013

No. 48.

CERTIFICATE OF DISCHARGE FROM BANKRUPTCY

THE HIGH COURT

BANKRUPTCY


No.

In the matter of ................., a Bankrupt.

[or as the case may be]

[Whereas A.B. of ................. was by Order of the Court made on the ...... day of ..........., 20....., adjudged bankrupt] or [Whereas by Order of the Court made on the ...... day of ............, 20...., it was ordered that the estate of C.D. deceased, late of .............. be administered under Part VI of the Bankruptcy Act 1988].

This is to certify that the said A.B. *[the said estate] has, pursuant to *[section

85] *[section 85B] of the Bankruptcy Act 1988, been discharged from bankruptcy.

Dated this ..... day of .......... 20.....

Signed .................

Official Assignee in Bankruptcy


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No. 49.
CERTIFICATE OF ANNULMUNT OF BANKRUPTCY
THE HIGH COURT
BANKRUPTCY
No.
In the matter of ...
a Bankrupt.
Whereas ... A. B. of ... was by Order of the Court made on the ... day of ... 19 , adjudged bankrupt.
This is to certify that the adjudication of the said ... A. B. has, pursuant to an Order of the Court made on the ... day of 19 ..., been annulled.
Given under seal of the Court this ... day of ... 19 ...
Examiner.
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S.I. No. 120 of 2012

No. 50

CERTIFICATION OF OFFICIAL ASSIGNEE OR TRUSTEE AS LIQUIDATOR WITHIN THE MEANING OF COUNCIL REGULATION (EC) No 1346/2000

THE HIGH COURT

BANKRUPTCY


No.

I, ............, the Master of the High Court of Ireland hereby certify

1. That the High Court made on the ....... day of .......... 20 ....

*an order that ......... of ............... be adjudicated bankrupt

*an order approving a proposal for vesting the property of ......... of ............, a debtor in the Official Assignee under Part IV of the Bankruptcy Act 1988

*an order for the administration under Part VI of the Bankruptcy Act 1988 of ......., late of ................ deceased.

2. By virtue of the said order of the High Court,

*.............. of Phoenix House, 15/24 Phoenix Street North, Smithfield, Dublin 7, Official Assignee,

*................ of ........., trustee,

is the liquidator (within the meaning of Article 2(b) of Council Regulation (EC) No.1346/2000 of 29 May 2000 on insolvency proceedings) of the assets of that person.

3. This certificate is issued in accordance with Article 19 of Council Regulation (EC) No.1346/2000 of 29 May 2000 on insolvency proceedings.

Dated the ........ day of ............. 20 .......

(Signed) ................

Master of the High Court.

(Seal)

*Delete where inapplicable.


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S.I. No. 316 of 2013
No. 51

O. 76A, r. 7(1)

THE HIGH COURT

PERSONAL INSOLVENCY ACT 2012


IN THE MATTER OF PART 3, *[CHAPTER 3] *[CHAPTER 4] OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [.......] OF [.......], A DEBTOR


CERTIFICATE UNDER SECTION *[61] *[95] OF THE PERSONAL INSOLVENCY ACT 2012

The Insolvency Service of Ireland, having considered the application for a protective certificate by the above named Debtor, a copy of which is furnished with this certificate, HEREBY CERTIFIES that the application is in order.

Dated this …. day of ……. 20..

*Signed:

*Director of the Insolvency Service of Ireland

*member of staff of the Insolvency Service of Ireland duly authorised by the Director of the Insolvency Service of Ireland

To: The Registrar,

Central Office,

Four Courts,

Dublin 7

[Note: this certificate, if furnished by electronic means to the Court, does not require to be authenticated by the signature of the person issuing it on behalf of the Insolvency Service of Ireland.]

The total liabilities of the debtor, determined on the basis of the Prescribed Financial Statement completed by the debtor concerned in respect of the application concerned, are in excess of €2,500,000.

*Delete where inapplicable


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S.I. No. 316 of 2013
No. 52

O. 76A, r. 7(3)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, CHAPTER 3 OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [.........] OF [.........], A DEBTOR

Before Mr/Ms Justice .....


PROTECTIVE CERTIFICATE

(DEBT SETTLEMENT ARRANGEMENT)


The Court

1. Being satisfied that the total liabilities of the debtor, determined on the basis of the Prescribed Financial Statement completed by the debtor concerned in respect of the application concerned, are in excess of €2,500,000

2. Having considered:

(i) the application dated the ...... 20... for the issue of a protective certificate in respect of the said debtor furnished to the Court on ...... 20.... by the Insolvency Service of Ireland

(ii) the certificate of the Insolvency Service of Ireland, having performed its functions under the Personal Insolvency Act 2012 in relation to the said application, that the application to the Insolvency Service of Ireland under section 59 of the Personal Insolvency Act 2012 on behalf of the said debtor is in order

(iii) copies of the supporting documentation for the application (other than the documents referred to in section 59(2)(f) and (g) of the Act)

*(iv) further *information *evidence provided to it

3. Being satisfied that the criteria specified in section 57 of the Personal Insolvency Act 2012 have been satisfied to the extent that the said criteria have not been disapplied by an order made under section 57(2) of the said Act

4. Being satisfied that the other relevant requirements relating to an application for the issue of a protective certificate have been met

hereby issues in accordance with section 61(2) of the Personal Insolvency Act 2012 a protective certificate in respect of the said debtor and in respect of the debts as set out hereunder:

Specified debts
Reference/Number (if any) as per Prescribed Financial StatementValue of the debt on the application date (€)Creditor to whom debt is owed
€ ………… of ….
Given by the Court on ..... 20.....

Registrar [Name]

*Delete where inapplicable


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S.I. No. 507 of 2015
No. 53

O. 76A, r. 11(1)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, *[CHAPTER 3] *[CHAPTER 4] OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [........] OF [........], A DEBTOR

NOTICE OF OBJECTION


TAKE NOTICE that ......... of ....., being a creditor of the above named debtor, in the amount of €......., having received on the .... day of ..... 20... a notice sent on the .... day of ....... 20... pursuant to

*section 75(2)1 of the Personal Insolvency Act 2012 concerning a proposed *(variation of a) Debt Settlement Arrangement

*section 112(2)2 of the Personal Insolvency Act 2012 concerning a proposed *(variation of a) Personal Insolvency Arrangement

*section 115A(3)3 of the Personal Insolvency Act 2012 concerning an application for an order under section 115A(9) of the Personal Insolvency Act 2012 in respect of a proposed Personal Insolvency Arrangement

in respect of the said debtor,

hereby gives notice of objection under *[section 75(3)] *[section 112(3)] *[section 115A(3)] of the Personal Insolvency Act 2012 to the coming into effect of the said proposed *(variation of a) *Debt Settlement Arrangement *Personal Insolvency Arrangement.

[Specify succinctly the grounds on which objection is made, as set out in

*section 87 of the Personal Insolvency Act 2012 in the case of a Debt Settlement Arrangement

*section 120 of the Personal Insolvency Act 2012, in the case of a Personal Insolvency Arrangement,

or the reasons for the objection where the objection is made under section 115A(3) of the Personal Insolvency Act 2012.]

Dated the ...... day of..... 20..

Creditor/Solicitor for creditor

To: The Registrar

Central Office

Four Courts Dublin 7

And to: the Insolvency Service of Ireland at ..................

And to: ........... of ..... personal insolvency practitioner appointed by the debtor.

*Delete where inapplicable

____________________________

1 As amended by section 8 of the Personal Insolvency (Amendment) Act 2015.
2 As amended by section 18 of the Personal Insolvency (Amendment) Act 2015.
3 Inserted by section 21 of the Personal Insolvency (Amendment) Act 2015.


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S.I. No. 507 of 2015
No. 54

O. 76A, rr. 11(2), 20(2)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, *[CHAPTER 3] *[CHAPTER 4] OF THE PERSONAL INSOLVENCY ACT 2012 AND IN THE MATTER OF [......] OF [.......], A DEBTOR

NOTIFICATION TO COURT BY INSOLVENCY SERVICE OF IRELAND UNDER SECTION *[76] *[113] OF THE PERSONAL


INSOLVENCY ACT 2012 The Insolvency Service of Ireland hereby notifies the Court that it has received notification from ...... of ......,

the personal insolvency practitioner appointed by the above named debtor, that

a *[Debt Settlement Arrangement] *[Personal Insolvency Arrangement]

*[has been] *[is deemed to have been] approved at a meeting of the creditors of the debtor

*[has been] *[is deemed to have been] approved by the only creditor of the debtor entitled to vote on the proposal

and that it has recorded such approval in the Register of *[Debt Settlement Arrangements] *[Personal Insolvency Arrangements].

This notification is accompanied by:

a true copy of the certificate provided under *section 75(1)(a)4 *section 75(1A)(a)5 *section 112(1)(a)6 *section 112(1A)(a)7 of the Act

a true copy of the approved *[Debt Settlement Arrangement] *[Personal Insolvency Arrangement] and

a true copy of the statement provided under *section 75(1)(c) *section 75(1A)(c) *section 112(1)(c) *section 112(1A)(c) of the Act.

Dated this ..... day of ..... 20...

*Signed:

*Director of the Insolvency Service of Ireland

*member of staff of the Insolvency Service of Ireland duly authorised by the Director of the Insolvency Service of Ireland

To: The Registrar
Central Office
Four Courts
Dublin 7

[Note: this notification, if furnished by electronic means to the Court, does not require to be authenticated by the signature of the person issuing it on behalf of the Insolvency Service of Ireland.]

*Delete where inapplicable

___________________________________

4 Substituted by section 71 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013.
5 Inserted by section 8 of the Personal Insolvency (Amendment) Act 2015.
6 As amended by section 85 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and substituted by section 18 of the Personal Insolvency (Amendment) Act 2015.
7 Inserted by section 18 of the Personal Insolvency (Amendment) Act 2015.


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S.I. No. 507 of 2015

No. 55


O. 76A, rr. 11(5), 20(5)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, *[CHAPTER 3] *[CHAPTER 4] OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [......] OF [..........], A DEBTOR

CERTIFICATE UNDER *[SECTION 75(1)(a)8] *[SECTION 75(1A)(a)9] *[SECTION 112(1)(a)10] *[SECTION 112(1A)(a)11] OF THE PERSONAL INSOLVENCY ACT 2012


*I, ........ of ........, personal insolvency practitioner, being the personal insolvency practitioner appointed by the above-named debtor to act as *his/ *her personal insolvency practitioner for the purposes of Chapter 3 of Part 3 of the said Act HEREBY CERTIFY pursuant to section 75(1)(a) of the said Act that the result of the vote taken at the creditors’ meeting concerning the proposed Debt Settlement Arrangement for the above-named debtor, held at ........ on the .... day of ....... 20... is as follows:
Percentage of total
Number of votes in value of the creditors present and voting100%
Number of votes in value of the creditors present and voting in favour of the proposed Debt Settlement Arrangement
Number of votes in value of the creditors present and voting against the proposed Debt Settlement Arrangement
*Creditors representing the requisite proportion of debts referred to in section 73(6)12 of the said Act have approved the proposal for a Debt Settlement Arrangement.

OR

*The proposed Debt Settlement Arrangement is deemed to have been approved under section 73(7)13 of the said Act, as no creditor at the meeting voted on the proposal.

OR

*Section 74A14 of the said Act applies to the proposed Debt Settlement Arrangement and the proposal *[has been approved] *[is deemed to have been approved] in accordance with section 74A(7) of the said Act by the only creditor entitled to vote on the proposal.

OR

*I, ...... of ........, personal insolvency practitioner, being the personal insolvency practitioner appointed by the above-named debtor to act as *his/ *her personal insolvency practitioner for the purposes of Chapter 4 of Part 3 of the said Act HEREBY CERTIFY pursuant to section 112(1)(a)15 of the said Act that the result of the vote taken at the creditors’ meeting concerning the proposed Personal Insolvency Arrangement for the above-named debtor, held at ..... on the .... day of ....... 20... is as follows:
Total debt (see paragraph (a) of section 110(1) of the said ActAmountPersentage of total
Total amount of debt owed to creditors present and voting100%
Total amount of debt in respect of which creditors present and voting voted in favour of the proposed Personal Insolvency Arrangement.....%
Total amount of debt in respect of which creditors present and voting voted against the proposed Personal Insolvency Arrangement.....%
Secure debt (see paragraph (b) of section 110(1) of the said ActValuePercentage of total
Total value of secured debt owed to secured creditors present and voting100%
Total value of secured debt in respect of which secured creditors present and voting have voted in favour of the proposed Personal Insolvency Arrangement.....%
Total value of secured debt in respect of which secured creditors present and voting have voted against the proposed Personal Insolvency Arrangement.....%
Unsecured debt (see paragraph (c) of section 110(1) of the said ActAmountPercentage of total
Total amount of unsecured debt owed to unsecured creditors present and voting100%
Total amount of unsecured debt in respect of which unsecured creditors present and voting have voted in favour of the proposed Personal Insolvency Arrangement.....%
Total amount of unsecured debt in respect of which unsecured creditors present and voting have voted against the proposed Personal Insolvency Arrangement.....%

*Creditors representing the requisite proportion of debts referred to in section 110(1)16 of the said Act have approved the proposal for a Personal Insolvency Arrangement.

OR

*The proposed Personal Insolvency Arrangement is deemed to have been approved under section 108(8)(a)17 of the said Act, as no creditor at the meeting voted on the proposal.

OR

*Section 111A18 of the said Act applies to the proposed Personal Insolvency Arrangement and the proposal *[has been approved] *[is deemed to have been approved] in accordance with section 111A(7) of the said Act by the only creditor entitled to vote on the proposal.

Dated this ..... day of ........ 20....

Signed:

To: The Registrar
Central Office
Four Courts
Dublin 7

*Delete where inapplicable

_________________________________

8 Substituted by section 71 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013.
9 Inserted by section 8 of the Personal Insolvency (Amendment) Act 2015.
10 As amended by section 85 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and substituted by section 18 of the Personal Insolvency (Amendment) Act 2015.
11 Inserted by section 18 of the Personal Insolvency (Amendment) Act 2015.
12 As substituted by section 6 of the Personal Insolvency (Amendment) Act 2015.
13 As amended by section 6 of the Personal Insolvency (Amendment) Act 2015.
14 As inserted by section 7 of the Personal Insolvency (Amendment) Act 2015.
15 As amended by section 85 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and substituted by section 18 of the Personal Insolvency (Amendment) Act 2015.
16 As amended by section 16 of the Personal Insolvency (Amendment) Act 2015.
17] As substituted by section 15 of the Personal Insolvency (Amendment) Act 2015. [18 Inserted by section 17 of the Personal Insolvency (Amendment) Act 2015.


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S.I. No. 507 of 2015
No. 56

O. 76A, rr. 11(5), 20(5)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, *[CHAPTER 3] *[CHAPTER 4] OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [......] OF [..........], A DEBTOR

STATEMENT UNDER *[SECTION 75(1)(c)19] *[SECTION 75(1A)(c)20] *[SECTION 112(1)(c)21] *[SECTION 112(1A)(c)22] OF THE PERSONAL INSOLVENCY ACT 2012


1. I,.... of......, personal insolvency practitioner, being the personal insolvency practitioner appointed by the above-named debtor to act as *his/*her personal insolvency practitioner for the purposes of *Chapter 3/*Chapter 4 of Part 3 of the said Act HEREBY CONFIRM

*for the purposes of section 78(2)23 and 78(5)24 of the said Act that I am of the opinion that—

(i) the said debtor satisfies the eligibility criteria for the proposal of a Debt Settlement Arrangement specified in section 57 of the said Act,

(ii) the approved Debt Settlement Arrangement complies with the mandatory requirements referred to in section 65(2)25 of the said Act, and

(iii) the approved Debt Settlement Arrangement does not contain any terms that would release the said debtor from an excluded debt, an excludable debt (other than a permitted debt) or a secured debt or otherwise affect such a debt.

*for the purposes of section 115(2)26 and 115(5)27 of the said Act that I am of the opinion that—

(i) the said debtor satisfies the eligibility criteria for the proposal of a Personal Insolvency Arrangement specified in section 9128 of the said Act,

(ii) the approved Personal Insolvency Arrangement complies with the mandatory requirements referred to in section 99(2)29 of the said Act, and

(iii) the approved Personal Insolvency Arrangement does not contain any terms that would release the said debtor from an excluded debt or an excludable debt (other than a permitted debt) or otherwise affect such a debt

Dated this ..... day of ...... 20....

Signed:

To: The Registrar
Central Office
Four Courts
Dublin 7

*Delete where inapplicable

19 Substituted by section 71 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013.
20 Inserted by section 8 of the Personal Insolvency (Amendment) Act 2015.
21 As amended by section 85 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and substituted by section 18 of the Personal Insolvency (Amendment) Act 2015.
22 Inserted by section 18 of the Personal Insolvency (Amendment) Act 2015.
23 As amended by section 73 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and by section 10 of the Personal Insolvency (Amendment) Act 2015.
24 As amended by section 73 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and by section 10 of the Personal Insolvency (Amendment) Act 2015.
25 As amended by section 67 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and section 100 of the Finance Act 2013.
26 As amended by section 87 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and by section 20 of the Personal Insolvency (Amendment) Act 2015.
27 As amended by section 87 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and by section 20 of the Personal Insolvency (Amendment) Act 2015.
28 As amended by section 79 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and by section 12 of the Personal Insolvency (Amendment) Act 2015.
29 As amended by section 100 of the Finance Act 2013.


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S.I. No. 316 of 2013
No. 57

O. 76A, r. 16(3)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, CHAPTER 4 OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [.........] OF [..........], A DEBTOR

Before Mr/Ms Justice .....


PROTECTIVE CERTIFICATE

(PERSONAL INSOLVENCY ARRANGEMENT)


The Court

1. Being satisfied that the total liabilities of the debtor, determined on the basis of the Prescribed Financial Statement completed by the debtor concerned in respect of the application concerned, are in excess of €2,500,000

2. Having considered:

(i) the application dated the ...... 20.. for the issue of a protective certificate in respect of the said debtor, furnished to the Court on ....... 20.. by the Insolvency Service of Ireland

(ii) the certificate of the Insolvency Service of Ireland, having performed its functions under the Personal Insolvency Act 2012 in relation to the said application, that the application to the Insolvency Service of Ireland under section 93 of the Personal Insolvency Act 2012 on behalf of the said debtor is in order

(iii) copies of the supporting documentation for the application (other than the documents referred to in section 93(2)(f) and (g) of the Act)

*(iv) further *information *evidence provided to it

3. Being satisfied that the criteria specified in section 91 of the Personal Insolvency Act 2012 have been satisfied to the extent that the said criteria have not been disapplied by an order made under section 91(3) of the said Act

4. Being satisfied that the other relevant requirements relating to an application for the issue of a protective certificate have been met

hereby issues in accordance with section 95(2) of the Personal Insolvency Act 2012 a protective certificate in respect of the said debtor and in respect of the debts as set out hereunder:

Specified debts
Reference/Number (if any) as per Prescribed Financial StatementValue of the debt on the application date (€)Creditor to whom debt is owed
€.............
of
........

Given by the Court on ........ 20.....

Registrar [Name]

*Delete where inapplicable


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S.I. No. 507 of 2015

No. 58


O. 76A, r. 21A(1)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, CHAPTER 4 OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [..........] OF [........], A DEBTOR

NOTICE OF MOTION FOR AN ORDER UNDER SECTION 115A(9)30 OF THE PERSONAL INSOLVENCY ACT 2012


TAKE NOTICE that on the ....... day of ....... 20.... at ....... in the forenoon or the first available opportunity thereafter, ........ of ......., personal insolvency practitioner, will apply to this Honourable Court sitting at the Four Courts, Dublin 7, for an order under section 115A(9) of the Personal Insolvency Act 2012 on behalf of the above-named debtor, AND FURTHER TAKE NOTICE of the following:

1. a proposal for a Personal Insolvency Arrangement (a copy of which is appended to this notice of motion) in respect of the said debtor has been made and has not been approved in accordance with Chapter 4 of Part 3 of the Personal Insolvency Act 2012;

2. the debts that would be covered by the proposed Personal Insolvency Arrangement include a relevant debt, within the meaning of section 115A(18) of the Personal Insolvency Act 2012;

3. *the creditors’ meeting referred to in section 115A(16)(a) of the Personal Insolvency Act 2012 was held on the .... day of ....... 20....*the date of receipt by me of the notice of the creditor concerned under section 111A(6)31 of the Personal Insolvency Act 2012 was the .... day of ....... 20....

4. I consider that there are reasonable grounds for the making of this application. The grounds of the application are:

[set out the grounds of the application; where for the purposes of the application it is intended to propose that any creditor(s) be considered as a class by the Court, set out clearly the grounds of such proposal];

5. the debtor has instructed me in writing to make this application, a copy of which instruction is appended to this notice of motion;

6. there is submitted with this application my report (a copy of which is appended to this notice of motion) referred to in section 107(1)(d) of the Personal Insolvency Act 2012;

†7. there is submitted with this application a certificate (a copy of which is appended to this notice of motion) with the result of the vote taken at the creditors’ meeting and identifying—

      (I) the proportions of the respective categories of votes cast by those voting at the creditors’ meeting, and

      (II) the creditors who voted in favour of and against the proposal, and the nature and value of the debt owed to each such creditor;

†7. section 111A32 of the Personal Insolvency Act 2012 applies to the proposal and the creditor concerned has notified me under section 111A(6) of the Act that the creditor does not approve of the proposal;

8. I am of the opinion that:

(a) the said debtor satisfies the eligibility criteria for the proposal of a Personal Insolvency Arrangement specified in section 9133 of the Personal Insolvency Act 2012.

(b) the proposed Personal Insolvency Arrangement complies with the mandatory requirements referred to in section 99(2)34 of the Personal Insolvency Act 2012;

(c) the proposed Personal Insolvency Arrangement does not contain any terms that would release the said debtor from an excluded debt or an excludable debt (other than a permitted debt) or otherwise affect such a debt.


ADDITIONAL NOTICE TO CREDITORS

TAKE NOTICE that you may, within 14 days of the date of the sending of this notice to you, lodge a notice with the High Court (in the Form No. 53 in Appendix O to the Rules of the Superior Courts), setting out whether or not you object to the application, and your reasons.

Appended to this notice of motion for issue are the following documents:

— Copy proposal for a Personal Insolvency Arrangement

— *Original certificate in Form No. 59 with the result of the vote taken at the creditors’ meeting

— Copy report of personal insolvency practitioner referred to in section 107(1)(d) of the Personal Insolvency Act 2012, and

— Copy of written instruction of debtor, certified to be a true copy.

Dated this day ...... of ....... 20.....

Signed:

Personal Insolvency Practitioner, of ........, on behalf of the above-named debtor

To: The Registrar
Central Office
Four Courts
Dublin 7
And To: Insolvency Service of Ireland
And To: the Debtor
And To: [each creditor concerned]

*Delete where inapplicable

†One alternative version of paragraph 7 only should be used and the other deleted

___________________________________________

30 Inserted by section 21 of the Personal Insolvency (Amendment) Act 2015.
31 Inserted by section 17 of the Personal Insolvency (Amendment) Act 2015.
32 Inserted by section 17 of the Personal Insolvency (Amendment) Act 2015.
33 As amended by section 79 of the Courts and Civil Law (Miscellaneous Provisions) Act 2013 and by section 12 of the Personal Insolvency (Amendment) Act 2015.
34 As amended by section 100 of the Finance Act 2013.


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Form 59

S.I No. 507 of 2015

FORM 59

O. 76A, r. 21A(2)

[Title as in Form No. 51]

IN THE MATTER OF PART 3, CHAPTER 4 OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [.............] OF [............], A DEBTOR

CERTIFICATE UNDER SECTION 115A(2)(d)35 OF THE PERSONAL INSOLVENCY ACT 2012


I, ..... of ......., personal insolvency practitioner, being the personal insolvency practitioner appointed by the above-named debtor to act as *his/ *her personal insolvency practitioner for the purposes of Chapter 4 of Part 3 of the said Act HEREBY CERTIFY pursuant to section 115A(2)(d) of the said Act that:

the result of the vote taken at the creditors’ meeting concerning the proposed Personal Insolvency Arrangement for the above-named debtor, held at ....... on the .... day of ..... 20... is as follows:

Creditors representing the requisite proportion of debts referred to in section 110(1) of the said Act have not approved the proposal for a Personal Insolvency Arrangement.

*[TABLE 1 (section 115A(2)(d)(i)(I))

The proportions of the categories of votes under section 110(1) cast by those voting at the creditors’ meeting were as follows:
Total debt (see paragraph (a)36 of section 110(1) of the said Act)AmountPercentage of total
Total amount of debt owed to creditors present and voting100%
Total amount of debt in respect of which creditors present and voting voted in favour of the proposed Personal Insolvency Arrangement.....%
Total amount of debt in respect of which creditors present and voting voted against the proposed Personal Insolvency Arrangement.....%
Secured debt (see paragraph (b) of section 110(1) of the said Act)ValuePercentage
Total value of secured debt owed to secured creditors present and voting100%
Total value of secured debt inrespect of which secured creditors present and voting have voted in favour of the proposed Personal Insolvency Arrangement.....%
Total value of secured debt in respect of which secured creditors present and voting have voted against the proposed Personal Insolvency Arrangement.....%
Unsecured debt (see paragraph (c) of section 110(1) of the said Act)AmountPercentage of total
Total amount of unsecured debt owed to unsecured creditors present and voting100%
Total amount of unsecured debt in respect of which unsecured creditors present and voting have voted in favour of the proposed Personal Insolvency Arrangement .....%
Total amount of unsecured debt in respect of which unsecured creditors present and voting have voted against the proposed Personal Insolvency Arrangement.....%

TABLE 2 (section 115A(2)(d)(i)(II))

The creditors who voted in favour of and against the proposal, and the nature and value of the debt owed to each such creditor, are as follows:
Identity of each creditor who voted in favour of the proposed Personal Insolvency ArrangementNature of the debt owed to such creditor and proposed class for the purposes of section 115A(17)(see grounds set out in notice of motionValue of the debt owed to such creditorProportion of debts due to creditors participating and voting at the creditors' meeting that is represented by the creditor
[insert an additional row for each creditor]
Identity of each creditor who voted against the proposed Personal Insolvency ArrangementNature of the debt owed to such creditorValue of the debt owed to such creditorProportion of debts due to creditors participating and voting at the creditors' meeting that is represented by the creditor
[insert an additional row for each creditor]
OR *[section 111A37 of the said Act applies to the proposal and ..........., the creditor concerned, has notified me under section 111A(6) that *he *she *it does not approve of the proposal.] Dated this day ..... of ...... 20.....

Signed:

To: The Registrar
Central Office
Four Courts
Dublin 7

And to:
The Insolvency Service of Ireland
nd to: [each creditor]

*Delete where inapplicable

__________________________
35 Inserted by section 21 of the Personal Insolvency (Amendment) Act 2015.
36 As amended by section 16 of the Personal Insolvency (Amendment) Act 2015.
37 Inserted by section 17 of the Personal Insolvency (Amendment) Act 2015.


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