Apply for an administration order

Published date21 March 2018
N92 Application for an Administration Order (Order 35, rule 2(1) (04.06) HMCS
Please read the notes for guidance (form N270) before
completing this form. Complete all details in black ink.
Application for an
administration order
The amount in
the account is
The account is
in credit by
The account is
overdrawn by
I am employed as a
Do you have any reason to believe that you may be able to
obtain employment within the next three months?
Complete all the boxes that apply. If you are not in paid
employment and are not seeking work eg. a homemaker,
you should say so in the unemployment section.
Name of court
Application no.
(For court use only)
Part A - Statement of means
Please complete the following statement of means as fully as
possible. Continue on a separate sheet if necessary.
1. Personal details
Full name
Address (including postcode)
Mr Mrs Miss Ms
Married Civil
Single Other
Date of birth
2. Dependants (people you look after nancially)
Number of children in each age group
under 11 11-15 16-17 18 and
Other dependants (give details)
3. Bank/Building society accounts and savings
I have a current account
I have a savings or deposit account
I have other savings or investments (give details)
4. Employment
My employer (including full address)
My works number and/or pay reference
Jobs other than main job (give details)
I have been unemployed for (say how long)
I am self employed as a
Give details of:
a) contracts and other work in hand
b) any sums due for work done
5. Property
amount due under a mortgage/
charges against property
value of property
jointly owned
my own
rented property other eg. with parents
I live in
I receive a pension
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