COUNTY COURT OF VICTORIA
250 William Street
MELBOURNE VIC 3000
DX 290078 Melbourne
Telephone: 8636 6508
Facsimile: 8636 6501
To the Judgment Debtor:
RE: APPLICATION UNDER JUDGMENT DEBT RECOVERY ACT
Please find enclosed application forms under the Judgment Debt Recovery Act to pay a debt by instalments.
These forms are:
1.
Form 61A - Application for an order to pay by instalments (2 pages).
2.
Affidavit of Financial Situation – providing information required by Form 72C(4 pages).
3.
Affidavit of Service.
Forms 61A and the Affidavit of Financial Situation are to be completed by you in triplicate, and the
affidavit sworn before a Court Registrar or Commissioner for Taking Affidavits.
After completion and swearing, send one copy of Form 61A and the affidavit to the Complainant's
Solicitors, (posting it to their address is acceptable) and complete the Affidavit of Service, which must be
sworn after completion before a Court Registrar or Commissioner for Taking Affidavits.
Then return to this office, Forms 61A, the Affidavit of Financial Situation and your Affidavit of
Service.
The additional copies of Forms 61A and the affidavit are to be retained by you.
DEPUTY REGISTRAR
COUNTY COURT
RULE 61.02(1)(a)
FORM 61A
APPLICATION TO REGISTRAR FOR ORDER FOR PAYMENT OF JUDGMENT DEBT BY
INSTALMENTS
IN THE COUNTY COURT
OF VICTORIA
AT
CI-___-_______
BETWEEN
Judgment Creditor
and
Judgment Debtor
Date of Document:
Filed on behalf of:
Prepared by:
Solicitors Code:
Telephone:
DX:
Ref:
This application is made to a Registrar by the [judgment creditor or judgment debtor] of [usual place of
residence or of business or registered office] with respect to the judgment for the [judgment creditor]
against the [judgment debtor] in the County Court dated the [e.g. 20 June 20 ] for $
and costs.
$
is now owing under the judgment, being—
(a) $
, the amount due under the judgment;
(b) $
, the amount of costs;
(c) $
, the amount of interest [if capable of calculation where the judgment debtor applies].
The [judgment creditor or judgment debtor] hereby applies for an order for the payment by instalments of
the sum owing under the judgment as follows:
[state amount of each instalment, weekly, monthly or other period for payment, number of instalments, date
of payment of first and last instalment, name and address of person to be paid].
The grounds on which the application is made are [complete appropriately].
The address for service of the [judgment creditor or judgment debtor] is
The usual or last known place of residence or of business or registered office of the [judgment debtor or
judgment creditor] is
Dated:
Signature of Applicant or Applicant's Solicitor
[Note that where the application is made by a judgment debtor, the judgment debtor must file an affidavit of
his or her financial situation which gives the information required by Form 72C.]
RULES 61.02(3)
JUDGMENT DEBTOR'S STATEMENT OF FINANCIAL SITUATION
IN THE COUNTY COURT
OF VICTORIA
AT
CI-___-_______
BETWEEN
Plaintiff
and
Defendant
I, (Judgment Debtor) ......................................................………….of (usual place of
residence) ....................................................................... make oath and say as follows:
The following is a true statement of my financial situation:
1.
AMOUNT AND SOURCE OF INCOME
Occupation: ............................................................
If working for an employer:
Name and address of employer: .................................................................
....................................................................................................................
Gross wage:
$....................
Current overtime (if any)
$....................
Car and other allowances and commission:
$....................
If self employed or in a partnership:
Average pre-tax earnings for last 12 months:
$ ...................
If unemployed:
State: length of last employment ..............................................
date when last employment ceased:
....../....../19.....
and: gross weekly amount earned:
$ ...................
Pension or other benefit received:
$ ...............................................
Worker's Compensation received: $ ...............................................
Maintenance received:
$ ...................
Superannuation received:
$ ...................
Board or Rent received:
$ ...................
Average weekly interest on bank or building society
deposit, debentures, etc:
$ ...................
Average weekly dividend on shares:
$ ...................
Other income (give particulars):
$ ...................
...................................................................................................
...................................................................................................
...................................................................................................
__________
TOTAL GROSS WEEKLY INCOME:
__________
$……………..
2.
PROPERTY AND ASSETS
Land, (including vacant land) at:
.........................................................................................................
For each piece of land:
Market Value
$ .....................................
Amount of Mortgage:
$ .....................................
Net Value:
$ .......................
Motor Vehicle:
For each motor vehicle:Year: ............ Make: ............... Model: .....................
Market Value:
$ ......................
Amount owing to Finance:
$ ......................
(Name of Company: .......................................)Net Value:
$ .......................
Deposit in bank account, building society, etc. (Give details):
...........................................................
$.................
...........................................................
$ .................
$ .......................
Total:
Other investments including shares, debentures, bonds:
............................................................
Money owing to you:
From whom? .......................................
From whom? .......................................
Total:
$ .......................
$ .................
$ .................
$ .......................
Value of interest in partnership or business (Give details):
...............................................................................
$ .......................
Furniture, household and personal goods:
...............................................................................
Market Value:
Amount Owing to
Finance Company:
(Name of Company: ..................)
$ .................
$ .................
Net Value
$ .......................
Life Insurance Policies (Give particulars and surrender value
of each policy):
.......................................................... $ .................
.......................................................... $ .................
Total: $ .......................
Other Assets (Give particulars):
.......................................................... $ .................
.......................................................... $ .................
Total: $ .....................
TOTAL OF PROPERTY AND ASSETS:
__________
$…………….
3. DEBTS, LIABILITIES AND OTHER FINANCIAL
OBLIGATIONS
(a) Weekly expenses: Income Tax:
Superannuation:
Housing
(Mortgage, rent, board, hospital or institution):
Municipal Rates:
Water and Sewerage Rates:
Land Tax:
Child care expenses incurred for the purpose of
earning income:
Maintenance actually paid:
Instalment payments such as for household goods
or tools of trade:
$ .......................
$ .......................
To: ...........................
$ .....................
To:...........................
$ ....................
Total: $ ....................
Electricity and Gas:
Food:
Other general household expenses:
Motor vehicle expenses (Registration,
Insurance, Maintenance, Fuel):
Fares:
Telephone:
Insurance policy premiums:
School Fees and other School expenses;
Clothing and shoes:
Medical and chemist expenses;
Entertainment:
$ ........………...
$ .......................
Payments on court orders and fines (Give particulars):
.......................................................................
........................................................................
Other expenses (Give particulars):
........................................
........................................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ .......................
$ ……………
$ .....................
$ .....................
TOTAL EXPENSES & DEBTS:
$……………..
__________
(b) Other debts outstanding:Give particulars of debts under Hire Purchase, Leasing, Credit Card
or other credit contracts, department store accounts, guarantee or personal loan:
$ ............., to .............................................. due on ....../....../......
$ ............., to .............................................. due on ....../....../......
Total:
$ .........................
4. If any of the assets referred to in paragraph 2 above is owned
jointly, identify each asset and give the name of the other
owner or owners:
................................................................................................................................
................................................................................................................................
................................................................................................................................
5. If any of the debts referred to in paragraph 3 is due jointly,
identify each debt and give the name of the other debtor
or debtors:
........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
6. Give particulars of any other circumstances which affect the
financial situation of the Judgment Debtor such as the number
and age of dependants, marital status and health:
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
Signature of Judgment Debtor:.......................................................
Sworn at Melbourne
This
/
/
Before me,
..........................................
A F F I D A V I T
O F
S E R V I C E
IN THE COUNTY COURT
OF VICTORIA
AT
B
E
T
W
E
E
NO:
N
Judgment Creditor
and
Judgment Debtor
Date of Document:
Filed on behalf of:
Prepared by:
Solicitors Code:
Telephone:
DX:
Ref:
I, ................................... the Judgment Debtor of .........................................................
OCCUPATION............................................
make oath and say:
“ THAT I served true copies of the Application to the Registrar for an order for
payment of Judgment Debt by Instalments, & Judgment Debtor's Affidavit of
Financial Situation.”
*by Posting/Delivering it to the Judgment Creditor's Solicitor/
................................................................................... at their address for service at
...........................................................................................................
OR *by serving the Judgment Creditor personally
at.........................................................................................................................
On the ................................. day of .......................... 20....... at.................
Signature of Judgment Debtor:.......................................................
Taken and sworn before me at
on this
day of
Before Me,
.............................................
in Victoria