Singapore legislation

Schedule 1

of Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020

Schedule 1

FIRST SCHEDULEForm PIR-1Rule 13(4)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020NOTICE OF RENEWAL OF ORIGINATING APPLICATION Renewed for months from the day of 20 by an order of Court dated the day of 20 . Dated this day of 20 . Solicitor for the[S 196/2022 wef 01/04/2022] Form PIR-2 Rule 64(1)(a) INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018) INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020 (Title) STATUTORY DEMANDUNDER SECTION 312 OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 Warning•This is an important document. You should refer to the notes entitled “How to comply with a statutory demand or have it set aside” in Part B of this demand.•If you wish to have this demand set aside you must make application to do so within *14 days/21 days/6 months after its service on you.•If you do not apply to set it aside within *14 days/21 days/6 months or settle your debts within **21 days/6 months after its service on you, you could be made bankrupt and your property and goods taken from you.•Please read the demand and notes carefully. If you are in any doubt about your position you should seek advice immediately from a solicitor or, if you qualify for legal aid, from the Director of Legal Aid. *Delete accordingly. Please refer to rule 67(2) of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 for the applicable period within which an application to set aside the statutory demand must be made.**Delete accordingly. Please refer to section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020. Demand To _______________________________________________________ Address ____________________________________________________________________________________________________________ This demand is served on you by the creditor — Name ____________________________________________________ Address ____________________________________________________________________________________________________________ The creditor claims that you owe the sum of $ ____________________, (Exact sum due as of date of demand) full particulars of which are set out in PART A of this demand, and that it is payable immediately and, to the extent of the sum demanded, is unsecured. The creditor demands that you pay the above debt or secure or compound for it to the creditor’s satisfaction within *21 days/6 months after the service of this statutory demand on you. If you fail to do so, the creditor may file a bankruptcy application against you. Signature of individual _______________________________________ Name (in Block Letters) ______________________________________ Date ______________________________________________________ **Position with or relationship to creditor ________________________ **I am authorised to make this demand on the creditor’s behalf. Address ____________________________________________________________________________________________________________ Tel. No. _________________Ref. ____________________ *Delete accordingly. Please refer to section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020.**Delete if signed personally by the creditor. PART A Particulars of Debt (These particulars must strictly be in accordance with rule 64(1)(a) of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020. The particulars must include actual amount of debt as of the date of the demand, details of interest claimed, date debt was incurred, consideration for the debt, such other particulars as would enable the debtor to identify the debt and any property of the debtor or security held by the creditor. If the debt has been assigned, particulars of the assignment must also be given.) PART B How to comply with this statutory demand or have it set aside. If you do not comply with this statutory demand or set it aside, the creditor may file a bankruptcy application against you. If you wish to avoid a bankruptcy application being made against you, you must pay the sum demanded, particulars of which are set out in Part A of this statutory demand, within the period of *21 days/6 months after its service on you. Alternatively, you can attempt to come to a settlement with the creditor within the said *21 days/6 months. To do this you should inform immediately the individual (or one of the individuals) named below that you are willing and able to — •offer security for the debt to the creditor’s satisfaction; or•compound for the debt to the creditor’s satisfaction If you consider that you have grounds to have this demand set aside or if you do not quickly receive a satisfactory written reply from the individual named below whom you have contacted, you should apply within **14 days/21 days/6 months after the date of service of this demand on you to the General Division of the High Court to have the demand set aside. Any application to set aside the demand should be made within **14 days/21 days/6 months after date of its service on you and be supported by an affidavit stating the grounds on which the demand should be set aside. If you are unable to make the application within **14 days/21 days/6 months after date of its service on you, you can apply to Court for more time to make the application. The individual or individuals to whom any communication regarding this demand may be addressed is/are — Name (in Block Letters) Address Tel. No. Ref. No. *Delete accordingly. Please refer to section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020.**Delete accordingly. Please refer to rule 67(2) of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 for the applicable period within which an application to set aside the statutory demand must be made. [S 1039/2020 wef 02/01/2021]Form PIR-3Rule 69(1)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020In the General Division of the High Court of the Republic of SingaporeIn Bankruptcy )O.A. No. )Of 20 )(Seal) In the matter of the Insolvency, Restructuring and Dissolution Act 2018 (Act 40 of 2018) And In the matter of Between Claimant And DefendantCREDITOR’S BANKRUPTCY APPLICATIONLet all parties concerned attend before the Judge (or Registrar) in chambers on (date/time) on the hearing of the application by the claimant that1. a bankruptcy order be made against (state name of defendant)2. (state name of trustee of bankruptcy), whose certificate of consent to act is annexed hereto, be appointed as trustee of the bankruptcy estate. Dated this day of 20 . RegistrarMemorandum to be subscribed on the summons.This summons is taken out by of solicitor for the said claimant whose address is [or where the claimant sues in person]. This summons is taken out by the said claimant who resides at and is [state occupation] and [if the claimant does not reside within the jurisdiction] whose address for service isNote: This summons shall be served together with an affidavit in support of the application. This summons may not be served more than 6 calendar months after the above date unless renewed by order of the court.EndorsementThis application has been filed in court on the day of 20 .If you intend to oppose this application you must not later than 3 days before the day fixed for hearing —

(a)

file in court a notice specifying the grounds on which you object to the making of a bankruptcy order;

(b)

send a copy of the notice to the claimant or his solicitor at the abovementioned address; and

(c)

send a copy of the notice to the Official Assignee at 45 Maxwell Road #07‑11, the URA Centre (East Wing), Singapore 069118.If a defendant does not attend personally or by his counsel or solicitor at the time and place abovementioned such order will be made as the court may think just and expedient.[S 196/2022 wef 01/04/2022][S 1039/2020 wef 02/01/2021]Form PIR-4Rule 77(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)AFFIDAVIT IN SUPPORT OFCREDITOR’S BANKRUPTCY APPLICATION I/We , of do make oath (or affirm) and say as follows:1. [explanation as to how rule 75 of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 is satisfied].

2. The defendant is justly and truly indebted to me/us in the aggregate sum of $_____________ [exact sum as of date of bankruptcy application], full particulars of which are set out in the annexure to this application which is marked ____ [The annexure shall be strictly in accordance with rule 71 of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 and include particulars of assignment of debt, if any].

3. The abovementioned debt is for a liquidated sum payable immediately and the defendant appears unable to pay it.

4. On __________, a statutory demand was served on the defendant by _______________ [manner of service] in respect of the abovementioned debt *during the prescribed period under the COVID‑19 (Temporary Measures) Act 2020. **21 days referred to in section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018/6 months referred to in section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 as modified by section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020 have lapsed since the service of the demand and to the best of my/our knowledge and belief, the demand has neither been complied with nor set aside in accordance with the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 and no application to set it aside is outstanding.*Delete these words if they do not apply.**Delete accordingly. Please refer to section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020.OR4. On __________, a statutory demand was served on the defendant by _______________ [manner of service] in respect of the abovementioned debt *during the prescribed period under the COVID‑19 (Temporary Measures) Act 2020. **21 days referred to in section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018/6 months referred to in section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 as modified by section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020 have not lapsed since the service of the demand and to the best of my/our knowledge and belief, the demand has neither been complied with nor set aside in accordance with the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 and no application to set it aside is outstanding. I/We believe that there is a serious possibility that the debtor’s property, or the value of all or any of the debtor’s property, will be significantly diminished after the service of the statutory demand and before the end of the period of **21 days referred to in section 312(a) of the Insolvency, Restructuring and Dissolution Act 2018/6 months referred to in section 312(a) of the Insolvency, Restructuring and Dissolution Act 2018 as modified by section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020. [further explanation as to how section 314 of the Insolvency, Restructuring and Dissolution Act 2018 is satisfied].*Delete these words if they do not apply.**Delete accordingly. Please refer to section 312(a)(i) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(e) of the COVID‑19 (Temporary Measures) Act 2020.OR4. On __________, a certificate of inapplicability under section 299 of the Insolvency, Restructuring and Dissolution Act 2018 was issued by the Official Assignee against the defendant, and to the best of my/our knowledge and belief, the defendant has not disputed the issuance of the certificate.OR4. On __________, a certificate of failure under section 300 of the Insolvency, Restructuring and Dissolution Act 2018 was issued by the Official Assignee against the defendant, and to the best of my/our knowledge and belief, the defendant has not disputed the issuance of the certificate.OR4. [Give particular of other grounds relied upon for application]5. I/We do not, nor does any person on my/our behalf, hold any security on the defendant’s estate, or any part thereof, for the payment of the abovementioned sum.OR5. I/We hold security for the payment of [part of] the abovementioned sum.I/We will give such security for the benefit of all the creditors in the event of a bankruptcy order being made.OR5. I/We hold security for the payment of part of the abovementioned sum and I/we estimate the value of such security to be $____________. This application is not made in respect of the secured part of my/our debt.

6. There has been no stay of enforcement in respect of this debt [for judgment debts only].

7. To the best of my/our knowledge and belief, I/we verily believe that the Debt Repayment Scheme applies to the defendant as the defendant —

(a)

does not have debts exceeding *$150,000/$250,000, or the aggregate of his unsecured debts in respect of which this bankruptcy application is made, does not exceed *$150,000/$250,000; (b)is not an undischarged bankrupt;

(c)

has not been a bankrupt in the 5 years preceding the date of this application;

(d)

is not presently subject to a voluntary arrangement;

(e)

has not been subject to a voluntary arrangement in the 5 years preceding the date of this application;

(f)

is not presently subject to a debt repayment scheme;

(g)

has not been subject to a debt repayment scheme in the 5 years preceding the date of this application;

(h)

is not a sole-proprietor;

(i)

is not a partner in a firm;

(j)

is not a partner in a limited liability partnership.(Note: The Debt Repayment Scheme does not apply to the applicant if the applicant fails to satisfy any of the conditions specified in paragraph 7 above.)*Delete accordingly. Please refer to section 289(2)(a) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(a) of the COVID‑19 (Temporary Measures) Act 2020.OR7. To the best of my/our knowledge and belief, I/we verily believe that the Debt Repayment Scheme does not apply to the defendant as the defendant —

(a)

has debts exceeding *$150,000/$250,000, or the aggregate of his debts in respect of which this bankruptcy application is made, exceeds *$150,000/$250,000;

(b)

is an undischarged bankrupt;

(c)

has been a bankrupt in the 5 years preceding the date of this application;

(d)

is presently subject to a voluntary arrangement;

(e)

has been subject to a voluntary arrangement in the 5 years preceding the date of this application;

(f)

is presently subject to a debt repayment scheme;

(g)

has been subject to a debt repayment scheme in the 5 years preceding the date of this application;

(h)

is a sole-proprietor;

(i)

is a partner in a firm;

(j)

is a partner in a limited liability partnership.(Note: Please delete the sub-paragraphs which you are not relying on to support your knowledge and belief.)*Delete accordingly. Please refer to section 289(2)(a) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(a) of the COVID‑19 (Temporary Measures) Act 2020.

8. The Official Assignee / [the name of the licensed insolvency practitioner] has consented to being appointed as trustee of the bankrupt’s estate. [A copy of the licensed insolvency practitioner’s licence is annexed.](Note: A copy of the licensed insolvency practitioner’s licence granted under section 53 of the Insolvency, Restructuring and Dissolution Act 2018 must be annexed if a licensed insolvency practitioner is being appointed as trustee of the bankrupt’s estate.)9. [Deleted by S 688/2023 wef 01/11/2023] Sworn (or affirmed) on the day of 20 ,at(through the interpretation of ) Before me Commissioner for Oaths[S 688/2023 wef 01/11/2023][S 196/2022 wef 01/04/2022]Form PIR-5Rule 77(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)AFFIDAVIT IN SUPPORT OF CREDITOR’S BANKRUPTCY APPLICATION ARISING FROM DEFAULT IN CONNECTION WITH VOLUNTARY ARRANGEMENT I/We , of do make oath (or affirm) and say as follows: 1.[explanation as to how rule 75 of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 is satisfied].2.On the day of 20 a voluntary arrangement proposal by the defendant was approved by his creditors and I am a creditor who is for the time being bound by the said voluntary arrangement/nominee supervising the said voluntary arrangement [The nominee supervising the said voluntary arrangement is (state name)].3.[give details of the defendant’s default under the voluntary arrangement, upon which the bankruptcy order is sought].4.A copy of the defendant’s proposal under the said voluntary arrangement is annexed to this application and marked Sworn (or affirmed) on the day of 20 ,at(through the interpretation of ) Before me Commissioner for OathsForm PIR-6Rule 88(2)(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)NOTICE OF INTENTION TO APPEAR AT HEARING OF BANKRUPTCY APPLICATION In the matter of a bankruptcy application filed on the day of 20 , to be heard on the day of 20 .I, [state full name and address] a creditor of the abovenamed defendant in respect of [state amount and nature of debt] intend to appear on the hearing of the abovementioned application and to [support][oppose] the application. Signed Name Date Address Tel. No. Ref. No.Form PIR-7Rule 95(3)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)NOTICE TO DEBTOR OF ORDER OF ADJOURNMENT OF HEARING OF BANKRUPTCY APPLICATION In the matter of a bankruptcy application filed on the day of 20 . Take notice that by order of the court dated the further hearing of the bankruptcy application has been adjourned to Date Time Place Signed (by the claimant or his solicitor) Name (name of claimant or his solicitor) Address Tel. No. Ref. No. To: [insert name and last known address of debtor][S 196/2022 wef 01/04/2022]Form PIR-8Rule 96(3)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)ORDER FOR SUBSTITUTION OF CLAIMANTON CREDITOR’S BANKRUPTCY APPLICATION Upon the hearing of this application this day of 20 , and upon the application of [name of creditor who wishes to be substituted as claimant] for an order that he be substituted as claimant therein pursuant to rule 96 of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020.And upon hearingAnd upon reading [details of statutory demand, return of execution etc.]It is ordered that the said be substituted as claimant in place of the said [name of original claimant in bankruptcy application] and that the said [name of new claimant] be at liberty to amend the said bankruptcy application accordingly.And it is ordered that the hearing of the said amended bankruptcy application be adjourned toDateTimePlace Dated this day of 20 . By the Court, Registrar [S 196/2022 wef 01/04/2022]Form PIR-9Rule 100(1)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020In the General Division of the High Court of the Republic of SingaporeIn Bankruptcy )O.A. No. )Of 20 )(Seal)DEBTOR’S BANKRUPTCY APPLICATION In the matter of the Insolvency, Restructuring andDissolution Act 2018 (Act 40 of 2018) And In the matter ofApplicantLet all parties concerned attend before the Judge/Registrar on (date/time) on the hearing of the application bythat1.a bankruptcy order be made against myself, [state name]; and2.[state name of trustee of bankruptcy], whose certificate of consent to act is annexed hereto, be appointed as trustee of my bankruptcy estate. Dated this day of 20 . RegistrarThis summons is taken out by of solicitor for the said applicant whose address is [or where the applicant appears in person]. This summons is taken out by the said applicant who resides at and is [state occupation] and [if the applicant does not reside within the jurisdiction] whose address for service is Note: This summons shall be served together with an affidavit in support of the application. This summons may not be served more than 6 calendar months after the above date unless renewed by order of the court.[S 196/2022 wef 01/04/2022][S 1039/2020 wef 02/01/2021]Form PIR-10Rule 101(1)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)AFFIDAVIT IN SUPPORT OFDEBTOR’S BANKRUPTCY APPLICATION I , of do make oath (or affirm) and say as follows:1.[explanation as to how rule 100(5) of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 is satisfied].2.I have assets worth $ and liabilities of $ owing to creditors.3.I am unable to pay my debts. The cause(s) of my insolvency is/are4.Prior to my filing of this bankruptcy application, I verily believe that the Debt Repayment Scheme applies to me as —

(a)

the aggregate of the unsecured debts specified in the statement of affairs exhibited in this affidavit does not exceed *$150,000/$250,000;

(b)

I am not an undischarged bankrupt;

(c)

I have not been adjudged a bankrupt in the 5 years preceding the date of this application;

(d)

I am not presently subject to a voluntary arrangement;

(e)

I have not been subject to a voluntary arrangement in the 5 years preceding the date of this application;

(f)

I am not presently subject to a debt repayment scheme;

(g)

I have not been subject to a debt repayment scheme in the 5 years preceding the date of this application;

(h)

I am not a sole-proprietor;

(i)

I am not presently a partner in a firm;

(j)

I am not presently a partner in a limited liability partnership. (Note: The Debt Repayment Scheme does not apply to the applicant if the applicant fails to satisfy any of the conditions specified in paragraph 4 above.) *Delete accordingly. Please refer to section 289(2)(a) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(a) of the COVID‑19 (Temporary Measures) Act 2020. OR4.Prior to my filing of this bankruptcy application, I verily believe that the Debt Repayment Scheme does not apply to me as —

(a)

the aggregate of the unsecured debts specified in the Statement of Affairs exhibited in this affidavit exceeds *$150,000/$250,000;

(b)

I am an undischarged bankrupt;

(c)

I have been adjudged a bankrupt in the 5 years preceding the date of this application;

(d)

I am presently subject to a voluntary arrangement;

(e)

I have been subject to a voluntary arrangement in the 5 years preceding the date of this application;

(f)

I am presently subject to a debt repayment scheme;

(g)

I have been subject to a debt repayment scheme in the 5 years preceding the date of this application;

(h)

I am a sole-proprietor;

(i)

I am presently a partner in a firm;

(j)

I am presently a partner in a limited liability partnership. (Note: Please delete the sub-paragraphs which you are not relying on to support your belief.) *Delete accordingly. Please refer to section 289(2)(a) of the Insolvency, Restructuring and Dissolution Act 2018 and section 21(1)(a) of the COVID‑19 (Temporary Measures) Act 2020.5.A statement of my affairs has been filed in court with this application.6.The Official Assignee / [the name of the licensed insolvency practitioner] has consented to being appointed as trustee of the bankrupt’s estate. [A copy of the licensed insolvency practitioner’s licence is annexed.] (Note: A copy of the licensed insolvency practitioner’s licence granted under section 53 of the Insolvency, Restructuring and Dissolution Act 2018 must be annexed if a licensed insolvency practitioner is being appointed as trustee of the bankrupt’s estate.) Sworn (or affirmed) on the day of 20 ,at(through the interpretation of ) Before me Commissioner for Oaths[S 688/2023 wef 01/11/2023]Form PIR-11Rule 102(1)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020STATEMENT OF AFFAIRSPART 1 1:Personal Details1.1Bankruptcy No.:_______________________________1.2Name:_______________________________1.3Any Other Names (Aliases, Maiden Name):_______________________________1.4NRIC/Passport/FIN No.:_______________________________1.5Latest ID No. (if any):_______________________________1.6Date of Birth:_______________________________1.7Nationality:_______________________________1.8Sex:Male / Female1.9Highest Educational Qualification:_______________________________1.10Race:_______________________________1.11Telephone No. (Home):_______________________________1.12Telephone No. (Mobile):_______________________________1.13Email Address:_______________________________1.14Address (As in NRIC):_______________________________1.15Correspondence Address (if different from above):_______________________________2:Family Particulars2.1Marital Status:_______________________________2.2Name of Spouse:_______________________________2.3Spouse ID Type:_______________________________2.4NRIC/Passport No. (Spouse):_______________________________2.5Spouse Net Income:_______________________________2.6If you own any HDB flat, please complete the following:Address of Flat:_______________________________ _______________________________ _______________________________Type of Flat:_______________________________Sole Owner / Joint Tenancy / Tenancy-In-Common (Share ___ %)Name of Co‑Owner(s):_______________________________ If you own a share in property(s) other than an HDB flat, please complete the tables at 2.1.4 and/or 2.2.2 of Part 2, where appropriate.2.7 Please provide the Name(s), Age(s) of all your children and individuals who are financially dependent on you.S/NNameAgeRelationshipEmployment Status1 2 3 4 5 Please provide details of your personal expenses and the expenses of the persons dependent on you.Your total monthly expenses:_______________________________Total monthly expenses for your family:_______________________________Please list the expenses below: 3:Employment Records 3.1Are you:Employed / Self-employed / Unemployed3.2If employed, please provide: Name of Employer:_______________________________ Job Title:_______________________________ Length of Service:_______________________________ Net Monthly Salary:_______________________________3.3If self-employed, please provide: Name of Business/UEN No.:_______________________________ Address of Business:_______________________________ Nature of Business:_______________________________ Net Monthly Salary:_______________________________3.4If unemployed, please provide: Name of Previous Employer:_______________________________ Previous Job Title:_______________________________ Last Date of Employment:_______________________________ Last Net Monthly Salary:_______________________________ Reason for Unemployment:_______________________________ Industry of Previous Employment:_______________________________ Last Held Position in Industry:_______________________________ Name & Relationship of person providing you financial support:_______________________________3.5 Do you have any other Sources of Income (e.g. income from rental of flat/room, any part time job)? Please state details of the source and amount of income received. 4: Bankruptcy Details and Business Ownership4.1 Were you previously adjudged a Bankrupt: Yes / No If “Yes”, please provide Bankruptcy Number: _____________ and Date of Discharge/Annulment: ____________4.2 Are you currently a director of any company or involved in the management of a company/ business? Yes / No4.3 Were you previously (in the last 5 years) a director of any company or involved in the management of a company/business? Yes / No4.4 If “Yes” for 4.2 or 4.3 or both, please give details of the company/business:S/NName of Company/BusinessUEN No.Nature of BusinessPosition in Company1 2 3 4 5 4.5 Are you presently involved in any Legal Proceedings: Yes / NoIf Yes, please provide the details requested below:S/NDescription of CaseCase Reference NumberName and Address of Solicitors1 2 3 4 5 4.6Main Cause(s) of Bankruptcy (Please tick only 1 box)□Business failure (e.g. director/business owner and acted as guarantor for company loans, company hire-purchase)□Claims against you as a result of criminal offences (e.g. criminal breach of trust, misappropriation of funds)□Gambling□Liabilities due to guarantees of a personal nature (e.g. acted as guarantor for friend/family)□Loss of income due to unemployment or retrenchment□Loss of income due to medical problems or ill health□Overspending on consumer goods/services (e.g. family expenses, purchase of luxury items)□Speculation (e.g. shares, properties, forex trading)□Others, please indicate _______________________________________ 4.7Source(s) of Debt Contributing to Bankruptcy (tick all that apply)□Credit facilities from financial institutions (e.g. overdraft facilities, credit cards, renovation loans, company loans)□Hire-purchase facilities□Loans from licensed moneylenders□Personal loans (e.g. loans from friends/family)□Others, please indicate _______________________________________ You may provide details on the cause(s) of your bankruptcy: PART 22: SUMMARY OF ASSETS AND LIABILITIES (Sections 2.1 & 2.2)AssetsAmount LiabilitiesAmountCash at Bank/In Hand Preferential Creditors Sundry Debtors Secured Creditors Personal Assets Unsecured Creditors Real Estate Assets Contingent Liabilities Business Assets Contingent Assets Total Assets (A) Total Liabilities (B) Total Assets (A) - Total Liabilities (B) = 2.1 Assets2.1.1 Cash at Bank (Savings/Current/Joint accounts/Fixed Deposits) and in Hand.S/NName of BankType of A/CA/C No.Foreign Currency (Indicate currency type)AmountAmount (SGD)1 2 3 4 5 6 7 8 9 10 2.1.2 Sundry Debtors (Individuals/Companies/Businesses that owe you money)S/NName of DebtorNRIC/UEN No.AddressDate Debt IncurredForeign Currency (Indicate currency type/amount)Amount (SGD)1 2 3 4 5 6 7 8 9 10 2.1.3 Personal Assets (Including Safe Deposit Box items, Insurance Policy, Vehicle, Trust/Will, Public or Private Limited Company Shares or Club Membership)Note: If you have any asset still under hire purchase [i.e., not fully paid], please declare it here and also under section 2.2.2 “Secured Creditors” section.S/NDescription of AssetRegistration/Account No.Location of AssetQuantityValue of Asset (SGD)1 2 3 4 5 6 7 8 9 10 2.1.4 Real Estate (Including Commercial, Industrial, Foreign Properties, Executive Condominiums, HUDC property.) (Excludes HDB flat e.g. Maisonette or 5‑room flat and below.)Note: If you have any property currently under mortgage [i.e., not fully paid], please declare it here and also under “Secured Creditors” section.S/NDescription of AssetAddressParticulars of Ownership (*Please select one)% ShareValue of Asset (SGD)Foreign Currency (Indicate currency type/amount)1 Sole Owner / Joint Tenancy / Tenancy-in-Common / Beneficial Owner 2 Sole Owner / Joint Tenancy / Tenancy-in-Common / Beneficial Owner 3 Sole Owner / Joint Tenancy / Tenancy-in-Common / Beneficial Owner 4 Sole Owner / Joint Tenancy / Tenancy-in-Common / Beneficial Owner 2.1.5 Business Assets (Inventory/Plant and Equipment/Furniture and Fittings)S/NDescription of AssetBusiness NameType of Business(*Please select one)UEN No.Location of Asset% ShareValue of Asset (SGD)Foreign Currency (Indicate currency type/amount)1 Sole Proprietor / Pte Ltd / Partnership 2 Sole Proprietor / Pte Ltd / Partnership 3 Sole Proprietor / Pte Ltd / Partnership 4 Sole Proprietor / Pte Ltd / Partnership 5 Sole Proprietor / Pte Ltd / Partnership 2.1.6 Contingent AssetsNote: This is for pending law suits or legal claims that you have against another party (ie, you are the claimant). If there is a counter-claim against you in the law suit, please declare the counter-claim under “Contingent Liabilities” section in 2.2.4 below. The relevant documents evidencing the law suit/legal claim must also be submitted. If there are outstanding loans owed to you currently being serviced and there is a guarantor for this loan, please declare said guarantor in this section.[S 196/2022 wef 01/04/2022]S/NNature of Contingency (*Please select one)Details of Suit or GuaranteeAmount Owed (SGD)Debtor’s NameDebtor’s ID No.Debtor’s Address1Pending Suit/ArbitrationGuaranteeOthers:______________General Division of the High Court / State Courts / Foreign CourtSuit No:_______________Guarantee No./Information_________________ 2Pending Suit/ArbitrationGuaranteeOthers:______________General Division of the High Court / State Courts / Foreign CourtSuit No:_______________Guarantee No./Information_________________ 3Pending Suit/ArbitrationGuaranteeOthers:______________General Division of the High Court / State Courts / Foreign CourtSuit No:_______________Guarantee No./Information_________________ 4Pending Suit/ArbitrationGuaranteeOthers:______________General Division of the High Court / State Courts / Foreign CourtSuit No:_______________Guarantee No./Information_________________ [S 1039/2020 wef 02/01/2021]2.2 Creditors2.2.1 Preferential Creditors (Employees e.g. wages, work injury compensation; Inland Revenue Authority of Singapore (‘IRAS’) e.g. income tax, property tax, Goods and Services Tax; Central Provident Fund (‘CPF’) Board e.g. CPF contribution, MediShield Life premiums, foreign worker levy)S/NName of CreditorID No. (NRIC/FIN)Description of LiabilityAmount Outstanding (SGD)1 2 3 4 5 6 7 8 9 10 2.2.2 Secured Creditors (Either Fully or Partly Secured) (e.g. Mortgages/Pledges/Lien/Charge/Hire Purchase Agreements)S/NName of CreditorAddressDescription of AssetAmount Owed (SGD) (A)Estimated Value (SGD) (B)Estimated Surplus/Deficit (SGD) (B-A)1 2 3 4 5 6 7 8 9 10 2.2.3 Unsecured Creditors (Personal Creditors, Licensed Moneylenders, Banks/Financial Institutions, other Businesses and Service Providers e.g. Telcos, utilities)S/NName of CreditorAddress(and NRIC No. where applicable)Amount Owed (SGD)Nature of DebtForeign Currency (Indicate currency type/amount)1 2 3 4 5 6 7 8 9 10 2.2.4 Contingent LiabilitiesNote: This is for law suits or legal claims that another party has against you (ie, you are the defendant). If there is a counter‑claim by you against the claimant in the law suit, please declare the counter‑claim under “Contingent Assets” section in 2.1.6 above. The relevant documents evidencing the law suit/legal claims must also be submitted. If you are currently a guarantor for any hire‑purchase or personal loans and these hire-purchase or loans are still being serviced and have not been defaulted upon, please declare in this section.[S 196/2022 wef 01/04/2022]S/NNature of Contingency (*Please select one)Details of Suit or GuaranteeAmount Owed (SGD)Creditor’s NameCreditor’s ID No.Creditor’s Address1Pending Suit/ArbitrationGuarantee Others:___________General Division of the High Court / State Courts / Foreign CourtSuit No:____________Guarantee No./Information______________ 2Pending Suit/ArbitrationGuaranteeOthers:___________General Division of the High Court / State Courts / Foreign CourtSuit No:____________Guarantee No./Information______________ 3Pending Suit/ArbitrationGuarantee Others:___________General Division of the High Court / State Courts / Foreign CourtSuit No:____________Guarantee No./Information______________ 4Pending Suit/ArbitrationGuarantee Others:___________General Division of the High Court / State Courts / Foreign CourtSuit No:____________Guarantee No./Information______________ [S 1039/2020 wef 02/01/2021]PART 33: Disposal of Assets before Bankruptcy3.1 Property Disposed 5 years prior to date of Bankruptcy ApplicationNote: Please declare all assets given away, transferred or sold in the last 5 years. This includes any assets given away, transferred or sold as a result of divorce proceedings or following a court order.S/NDescription of AssetEstimated Market Value or Fair Value of AssetDate of Sale/Transfer/DisposalName of Buyer/TransfereeNet Sale Proceeds1 2 3 4 5 3.2 Repayment of Debt(s) to creditors before and after date of Bankruptcy ApplicationNote: If you made payment to any creditor in the last 2 years before the date of Bankruptcy Application or payment to any creditor after the date of the Bankruptcy Application, please provide the information below:S/NCreditorID No. (NRIC/FIN)Amount OwedAmount PaidRelationshipDate of Repayment1 2 3 4 5 Form PIR-12Rule 102(2)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018 (ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION (PERSONAL INSOLVENCY) RULES 2020In the General Division of the High Court of the Republic of Singapore IN BANKRUPTCY NO. OF RE: AFFIDAVIT VERIFYING STATEMENT OF AFFAIRSI, ............................................................ of .......................................................... holder of Singapore NRIC / Passport No. / Identification No. ............................. *make oath / affirm and say that the particulars contained in the statement of affairs – PARTS 1, 2 and 3 relating to *myself / the abovenamed firm which are *submitted electronically / signed by me on .................... 20..... are true and complete to the best of my knowledge and belief. *Sworn / Affirmed at )this day of 20 ) Before me, ___________________Commissioner for Oaths* Delete where appropriate[S 1039/2020 wef 02/01/2021]Form PIR-13Rule 107(2)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)BANKRUPTCY ORDER ON CREDITOR’S APPLICATION Upon the application of [Name and address of claimant], a creditor, which was filed on the day of 20 , and upon reading the affidavit ofAnd upon hearingIt is ordered that [full description of debtor as set out in the application] be adjudged bankrupt [and it is ordered that be appointed trustee of the bankrupt’s estate] Dated this day of 20 . By the Court, Registrar Notice to the BankruptUpon written notification by the Official Assignee / trustee in bankruptcy*, please comply with the instructions contained in the written notification from the [Official Assignee / trustee in bankruptcy].*Delete accordingly.ENDORSEMENT ON ORDERThe solicitor to the claimant isNameAddressTel. No.Ref. No.[S 688/2023 wef 01/11/2023][S 196/2022 wef 01/04/2022]Form PIR-14Rule 107(3)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)BANKRUPTCY ORDER ON DEBTOR’S APPLICATION Upon the application of the abovenamed debtor, which was filed on the day of 20 ,And upon hearingAnd upon reading the affidavit and statement of affairs ofIt is ordered that [insert full description of debtor as set out in the debtor’s bankruptcy application] be adjudged bankrupt.[And it is ordered that be appointed trustee of the bankrupt’s estate] Dated this day of 20 . By the Court, Registrar Notice to the BankruptUpon written notification by the Official Assignee / trustee in bankruptcy*, please comply with the instructions contained in the written notification from the [Official Assignee / trustee in bankruptcy].*Delete accordingly.[S 688/2023 wef 01/11/2023]Form PIR-15Rule 113(1)(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)APPLICATION FOR INTERIM RECEIVER I, ________________________________, do, on the grounds set forth in (Name of applicant) the annexed affidavit, apply to the court to appoint the Official Assignee as Interim Receiver of the property or part of the property of __________________ (Name of debtor)and _________________________________________________________(Any special directions to the Official Assignee that may be desired) Dated this day of 20 . Signature of ApplicantForm PIR-16Rule 113(2)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)ORDER APPOINTING INTERIM RECEIVER Upon reading this application and the affidavit therein referred to, and hearing _________________________________, it is ordered that upon a deposit of $____________ being lodged by the applicant, the Official Assignee be thereupon appointed Interim Receiver of the property or part of the property of the said _______________________________(Name of debtor) _____________________________________________________________(Nature, short description and locality of the property and special directions, if any) Dated this day of 20 . By the Court, Registrar Form PIR-17Rule 117(1)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)APPLICATION FOR AN ORDER FOR AN EXAMINATIONUNDER SECTION 335(1) OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 A Bankruptcy Order having been made in the above matter, application is hereby made to the court by _____________________________________(Name, address and capacity of applicant)for an order appointing such date, time and place as the court shall direct for holding an examination of ______________________________________________________________________________________________________(Name, NRIC/Passport No. and address)and that he does attend such examination. Dated this day of 20 . (Signature) AddressForm PIR-18Rule 117(2)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)ORDER APPOINTING A DATE FOR AN EXAMINATIONUNDER SECTION 335(1) OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 Upon the application of ______________________________________(Name and address of applicant)it is ordered that the examination of ________________________________(Name, NRIC/Passport No. and address)is to be held at __________________________________________________(Venue)on the day of 20 at _________.(Time)And it is ordered that the abovenamed person do attend at the date, time and place abovementioned. Dated this day of 20 . By the Court, Registrar Note: Notice is hereby given that if you fail to attend at the date, time and place mentioned above without reasonable excuse, you will be liable to be committed to prison without further notice.Form PIR-19Rules 121(3), 122(4) and 123(3)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)NOTICE OF APPLICATION TO REVIEW/VARY MONTHLY CONTRIBUTION AND TARGET CONTRIBUTION UNDER SECTION *340(4)/341(4)/343(3)(b) OF INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018 Take notice that [insert name of bankrupt or creditor], who is a *bankrupt/creditor is dissatisfied with the bankrupt’s monthly contribution and target contribution determined by the *[Official Assignee/trustee in bankruptcy] and he/she has applied to the court to review the monthly contribution and target contribution.ORTake notice that the *[Official Assignee/trustee in bankruptcy/bankrupt/creditor] has applied to the court to vary the bankrupt’s monthly contribution and target contribution.#A copy of the application is attached herein.The hearing of the application has been fixed on [insert date] at [insert time of hearing] at [insert venue of hearing]. Signed (by *Official Assignee/trustee in bankruptcy) Address Dated this day of 20 .To: #If upon the request of any person given notice of the application.*Delete where appropriateForm PIR-20Rules 121(5)(a), 122(5)(a) and 123(5)(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)NOTICE OF VARIATION ORDER UNDER SECTION *340(8)/341(7)/343(7) OF INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018 Upon the application of *[Official Assignee/trustee in bankruptcy/bankrupt/creditor], which was filed on the day of 20 .The General Division of the High Court ordered that the monthly contribution and the target contribution *not be varied. / be varied to be the sums of (i) $ and

(ii)

$ respectively.The variation of the monthly contribution and the target contribution takes effect on [Insert Date].A copy of the variation order is attached. Dated this day of 20 . Official Assignee/trustee in bankruptcy (Signature)Address To: *Delete where appropriate[S 1039/2020 wef 02/01/2021]Form PIR-21Rule 130(1)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)NOTICE TO BANKRUPTUNDER SECTION 372 OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 Take notice that an application has been made by [Official Assignee/trustee in bankruptcy] to this court on the day of 20 , for an order under section 372 of the Insolvency, Restructuring and Dissolution Act 2018 for the payment of a part of your salary, income, half‑pay, pension, or compensation to me as trustee for the benefit of the creditors under your bankruptcy.A copy of the application is attached herein.The hearing of the application has been fixed on [insert date], [insert time] at [insert place].You are at liberty to show cause against this order being made against you. Dated this day of 20 . Signed (by Official Assignee/trustee in bankruptcy)Form PIR-22Rule 131(1)(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)ORDER SETTING ASIDE PAY OR SALARYUNDER SECTION 372(1) OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 Whereas it appears to the court that the bankrupt is an officer of the Singapore Armed Forces or a public officer or otherwise employed or engaged in the public service of the Government (select where appropriate), and as such is in receipt of the monthly pay (or salary) of about ___________ dollars; and whereas upon the application of the *Official Assignee/trustee in bankruptcy and upon hearing the bankrupt, it appears to the court just and reasonable that the monthly sum of _____________ dollars, a portion of the said pay (or salary) ought to be paid to the *Official Assignee/trustee in bankruptcy during the bankruptcy, in order that the same may be applied in payment of the debts of the bankrupt, and that such payment ought to be made out of the first moneys which shall be due after the _________ day of ____________ 20 , and be continued until this court shall make order to the contrary; it is ordered, that such portion of the pay (or salary) shall be paid to the *Official Assignee/trustee in bankruptcy [insert trustee’s name if trustee has been authorised to receive the moneys] accordingly. Dated this day of 20 . By the Court, Registrar *Delete where appropriateForm PIR-23Rule 131(1)(b)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)ORDER SETTING ASIDE SALARY OR INCOMEUNDER SECTION 372(2) OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 Whereas it appears to the court that the bankrupt is in the receipt of (or entitled to) a salary (or income, half‑pay, pension, or compensation granted by the Government, as the case may be) of about ___________ dollars; as (here set forth the circumstances under which the salary or income is received):And whereas upon the application of the *Official Assignee/trustee in bankruptcy and upon hearing the bankrupt, it appears to the court just and reasonable that the monthly sum of _____________ dollars, a portion of the said salary (or income, etc.) ought to be paid by the bankrupt by monthly payment to the *Official Assignee/trustee in bankruptcy [insert trustee’s name if trustee has been authorised to receive the moneys] during the bankruptcy, in order that the same may be applied in payment of the debts of the said bankrupt, and that the first of such payment ought to be made on the ___ day of ____________ 20 , and be continued monthly until this court shall make order to the contrary; it is ordered that the said sum shall be paid by ______________________________ in the manner aforesaid out of the bankrupt’s salary (or income, etc.). Dated this day of 20 . By the Court, Registrar *Delete where appropriateForm PIR-24Rule 172INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020In the General Division of the High Court of the Republic of SingaporeIn Bankruptcy )O.A. No. )Of 20 )CREDITOR’S APPLICATION FORADMINISTRATION OF ESTATE OF DECEASED DEBTORUNDER SECTION 419 OF INSOLVENCY,RESTRUCTURING AND DISSOLUTION ACT 2018 In the matter of the Insolvency, Restructuring and Dissolution Act 2018 (Act 40 of 2018) And In the matter of Between Claimant And DefendantLet all parties concerned attend before the Judge (or Registrar) in chambers on (date/time) on the hearing of the application by the claimant that —1. An order be made for the administration in bankruptcy of the estate of the late [state full particulars of deceased debtor], who died on the ______ day of _________ 20 ;2. The Official Assignee be appointed as trustee of the deceased debtor’s estate in bankruptcy. Dated this day of 20 . RegistrarThis summons is taken out by of solicitor for the said claimant whose address is [or where the claimant sues in person]. This summons is taken out by the said claimant who resides at and is [state occupation] and [if the claimant does not reside within the jurisdiction] whose address for service is Note: This summons shall be served together with an affidavit in support of the application. This summons may not be served more than 6 calendar months after the above date unless renewed by order of the court.EndorsementThis application has been filed in court on the day of 20 .And you, [Name of Executor/Administrator of deceased’s estate] are to take notice that if you intend to oppose this application you must not later than 3 days before the day fixed for hearing —

(a)

file in court a notice specifying the grounds on which you object to the making of an administration order;

(b)

send a copy of the notice to the claimant or his solicitor at the abovementioned address; and

(c)

send a copy of the notice to the Official Assignee at [state address].If a defendant does not attend personally or by his counsel or solicitor at the time and place abovementioned, such order will be made as the court may think just and expedient.[S 196/2022 wef 01/04/2022][S 1039/2020 wef 02/01/2021]Form PIR-25Rule 172INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)AFFIDAVIT IN SUPPORT OFCREDITOR’S APPLICATION FOR ADMINISTRATION OFESTATE OF DECEASED DEBTOR UNDER SECTION 419 OFINSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018 I/We ___________________________, of _________________________ do make oath (or affirm) and say as follows:1.[explanation as to how rule 75 of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 is satisfied].2.The estate of the said deceased is justly and truly indebted to me/us in the aggregate sum of $_____________ [exact sum as of date of bankruptcy application], full particulars of which are set out in the annexure to this application which is marked ____ [The annexure shall be strictly in accordance with rule 71 of the Insolvency, Restructuring and Dissolution (Personal Insolvency) Rules 2020 and include particulars of assignment of debt, if any].3.The abovementioned debt is for a liquidated sum payable immediately.4.I/We do not, nor does any person on my/our behalf, hold any security on the deceased debtor’s estate, or any part thereof, for the payment of the abovementioned sum. OR4.I/We hold security for the payment of [part of] the abovementioned sum. I/We will give such security for the benefit of all the creditors in the event of an order for administration in bankruptcy being made. OR4.I/We hold security for the payment of part of the abovementioned sum and I/we estimate the value of such security to be $____________. This application is not made in respect of the secured part of my/our debt.5.The assets of the estate are as follows [state description and estimation or actual value].6.The will of the said deceased debtor was on the day of 20 , proved by [state name and address of Executor(s)]. OR6.The letters of administration were on the day of 20 , granted to [state name and address of Administrator(s)].7.The total assets of the estate are to my knowledge and information insufficient to settle the debts of the estate.8.There has been no stay of enforcement in respect of this debt. [applicable to judgment debts only].9.[any other relevant information]. Sworn (or affirmed) on the day of 20 ,at(through the interpretation of ) Before me Commissioner for OathsNote: If the applicant is the Official Assignee, paragraphs 2, 3 and 4 do not apply.[S 196/2022 wef 01/04/2022]Form PIR-26Rule 176(a)INSOLVENCY, RESTRUCTURING AND DISSOLUTION ACT 2018(ACT 40 OF 2018)INSOLVENCY, RESTRUCTURING AND DISSOLUTION(PERSONAL INSOLVENCY) RULES 2020(Title)ORDER FOR ADMINISTRATION OF ESTATE OF DECEASED DEBTOR Upon the application of [Name and address of claimant], a creditor, which was filed on the day of 20 , and upon reading the affidavit ofAnd upon hearingIt is ordered that an order be made for the administration of the estate of [full description of debtor as set out in the application] [and it is ordered that the Official Assignee be appointed trustee of the deceased debtor’s estate] Dated this day of 20 . By the Court, Registrar Notice to the Legal Representative of the Deceased DebtorYou are required to attend upon the Official Assignee at his office at 45 Maxwell Road #07-11, the URA Centre (East Wing), Singapore 069118 upon written notification by the Official Assignee. The Official Assignee’s office is open every Monday to Friday (except public holidays) from 8.30 a.m. to 5.00 p.m.ENDORSEMENT ON ORDERThe solicitor to the claimant isNameAddressTel. No.Ref. No.[S 196/2022 wef 01/04/2022]