Bankruptcy Questionnaire

June 10, 2011

Name:               __________________________________________________________________

Address:        __________________________________________________________________

Phone:               ______________         _______________               __________________                  (home)                                (work)                             (cell)

Email:               ________________________        Birthdate:  ____ _____        _________

mm    dd       yyyy

Social Security Number:         ______________________________________________________

  1. Your marital status:-
    1. Married
    2. Unmarried
    3. Divorced
  1. If you have not lived at your present address for more than two years then give details of your past address(s)

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  1. Have you applied for bankruptcy before? If yes then furnish all the details

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  1. Do you have any dependents living with you? If yes then write their name, age and relationship to you.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

  1. If you own any real estate property(s) then mention address and ownership details, mortgage holders(if any) etc.

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  1. Furnish details of your bank accounts, with bank address, account type, and average balance, security deposits, fixed deposits etc

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

  1. If you own any of these please state the id number, build, make and time of buying market price. Furnish complete details
    1. Motor vehicles
    2. Boats
    3. Books, Pictures
    4. Furniture and jewelries
    5. Sport equipments
    6. Electrical appliances
  2. If you are liable to pay any loans, debts or taxes please mention them in detail

___________________________________

Download Bankruptcy Questionnaire in Word Format

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