Form EX140
| Published date | 21 March 2018 |
1
Record of examination
(Individual)
In the
Claim No.
Appn. No.
EX140 Record of examination (individual) (04.03) Printed on behalf of The Court Service
Full Name
Present
address
Do you intend moving to
another address?
National
insurance no.
Phone numbers:
home
mobile
Are you
Personal Information
Your age?
Do you have any
dependant children?
Name Age
Judgment Creditor:
Judgment Debtor:
Yes
No
If Yes, what will your
new address be and
when are you moving?
married? single?
separated? divorced?
living with partner?
Do you have other
dependants living with you,
eg. elderly relatives?
If Yes, what are their
names and ages?
If Yes, what are their
names and ages and
to what extent are they
dependant?
work
other
Yes
No
Yes
No
Date
1
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