List of creditors furnished under the Act of 1971
| Published date | 21 March 2018 |
| Subject Matter | County Court forms |
IN THE COUNTY COURT
BETWEEN...............................................................CLAIMANT CLAIM No.
AND ........................................................................ DEFENDANT ATTACHMENT
APPLICATION No.
I, ..............................................................................
of .....................................................................................................................................................
the above named defendant, state that I owe the persons mentioned in the list below, including the claimant in this
action, the sums given opposite their names, which do not total more than £5000. To the best of my knowledge I
am not indebted to any other person whatsoever.
If an order is made for the administration of my estate, I request that it may provide for the payment of my debts in
full [or to the extent of pence in the pound] by instalments of £
for every month
LIST OF CREDITORS
PLEASE COMPLETE USING BLACK INK
Name of creditor (and claim
number in the claim of a
judgment debt). If known,
give creditor’s reference number.
Address and description of creditor Amount of
debt
£p
Name and address of
any other person liable
for the debt.
Particulars and
estimated
value of any
security in
respect of the
debt.
CARRIED
FORWARD £
NOTE: The claimant’s judgment debt must be inserted as well as all other debts.
If any of the above creditors, in addition to the claimant, has sued the defendant in any court, the claim or order in each case must be produced to the District
Judge.
N93 - w3 List of Creditors (4.99) Printed on behalf of The Court Service
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