Title: Bankruptcy Act 1966

Bankruptcy Act 1966 |

Form  5  (16 November 2006)
Section 54A

Declaration of Intention to Present a Debtor’s Petition
Please read the notes overleaf carefully before filling in this form

Debtor Details
Title | Mr | ☐ | | Mrs | ☐ | | Ms | ☐ | | Miss | ☐ | | Other |
Family Name | Print name
Given names |
Residential address |
| | Postcode
Current Occupation |
Date of Birth | /       / |
Phone number | Home | Fax | Work
Email |
Other names used |
in the past 10 years |

☐ I have received the Prescribed Information about the alternatives to, and consequences of, bankruptcy and sources of financial advice and guidance.
☐ I am not aware of any reasons that prevent me from declaring my intention to present a petition against myself*.
*(see information)

Pursuant to section 54A of the Bankruptcy Act 1966, I declare that it is my intention to present a debtor’s petition.
Signature of the Debtor | Date        /       /

Note. If you want confirmation of the acceptance of this Declaration of Intention faxed to another person (eg. the Sheriff, your paymaster) please show their details in the box below:

Contact name | | Fax
Email address | If any |

Declaration by interpreter or other person who has helped a debtor complete this form.
Before this declaration of intention was completed, I interpreted and explained the contents of this form to the debtor and ensured that the debtor understood the implications of signing this declaration.  
print 	Family Name	Given names
Signature of the Interpreter | Date        /       /

Office Use Only | | Matter Number | | By
Date DOI Presented | | Date DOI Accepted | | For Official Receiver

Stay period in force from 12.01am on        /       /       to 12.00midnight on        /       /      

INFORMATION FOR DEBTORS

Lodging this declaration

You should carefully read the Prescribed Information booklet before presenting this declaration.  This declaration needs to be lodged (faxed, mailed or delivered in person) at your nearest ITSA office.  It only provides you with temporary relief from enforcement action by some creditors (see creditor information below).  

ITSA returns a sealed copy of the declaration to you so that you can produce it to your creditors/the sheriff to stop any enforcement action.  ITSA does not advise your creditors that you have lodged this declaration.

The information provided on this declaration is not recorded on the National Personal Insolvency Index which is a perpetual public record.  

ITSA does not give advice on whether making this declaration or subsequently petitioning for bankruptcy is suitable to your individual circumstances.  If you need assistance to make this decision, it is recommended that you speak with a financial counsellor, an accountant or solicitor.  For further information on bankruptcy or any of its alternatives, addresses of ITSA offices and financial counsellors, and the Prescribed Information booklet please call ITSA on 1300 364 785 or visit www.itsa.gov.au.  

You cannot present this declaration if: 

1. a creditor has petitioned for your bankruptcy and that  petition has not been dealt with or has not lapsed
2. you have already petitioned for your own bankruptcy and that petition has not been dealt with
3. your property is subject to the control of a trustee under Part X 
4. you have signed an authority giving control of your property to a trustee under Part X within the last six months
5. you have previously presented a declaration that was accepted by the Official Receiver within 12 months of this declaration
6. any court order prevents you from making this declaration

Act of Bankruptcy

You commit an act of bankruptcy if you present this declaration.  This means that should you decide after the end of the stay period not to proceed with your intention to petition for bankruptcy and you have not otherwise come to a settlement with your creditors, a creditor who is owed $2,000 or more can apply to the court to make you bankrupt.

INFORMATION FOR CREDITORS

Stay of enforcement action

If the Official Receiver accepts this declaration, on production of the accepted declaration, a creditor cannot apply for the issue of enforcement process in respect of the debt or take enforcement action (seize goods or attach wages) in respect of a debt owed by the debtor for a period of 7 days (stay period).  The stay period automatically ends before the expiry of the 7 days in certain instances such as if the debtor signs an authority under S188 of the Bankruptcy Act 1966, files for bankruptcy, if a creditor petitions to make the debtor bankrupt or the court declares the debtor bankrupt.

Certain creditors not affected

Acceptance of this declaration by the Official Receiver does not affect the rights of certain creditors such as secured creditors, and enforcement action can still proceed for certain types of debts (eg. maintenance agreements, court imposed fines, etc)

Sheriff’s duties

Where, during the stay period, a copy of the declaration signed by the Official Receiver is produced to a sheriff,
the sheriff shall refrain from taking action, or further action, to execute, or to sell property under, enforcement process issued in respect of a frozen debt owed by the debtor. The sheriff shall refrain from paying to person proceeds of enforcement process issued in respect of a frozen debt owed by the debtor. 

Effect on garnishee notices

If the Official Receiver accepts this declaration, on production of the accepted declaration, the person making deductions under a garnishee notice must for the period of the stay refrain from retaining or deducting money. They must also refrain from paying to a person (other than the debtor), or otherwise applying, money that was so retained or deducted before the signed copy was produced to that person.

Duty of Court Registrar

Where a copy of the declaration signed by the Official Receiver is produced to the registrar or other appropriate officer of the court, they shall, throughout the period of the stay, refrain from paying to a person proceeds of enforcement process issued in respect of a frozen debt owed by the debtor.