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Acknowledgement

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					                         Acknowledgement
                         That I have received and read this
                          Prescribed Information booklet


If you proceed with a:

• Declaration of Intention to Present a Debtor’s Petition (p.3) or
• Debt Agreement (p.4)
• bankruptcy (p.8)

you are required to advise ITSA that you have received and read this booklet.

You must now:

• Sign and detach this page
• Lodge it with your documents.



Have you read the information in this booklet?                          □
(the Prescribed Information)

or


Have you had this booklet read to you or translated for you?            □

Have you considered the alternative options                             □
Described on p. 3-7 of this booklet?



Have you read the consequences of bankruptcy (p.18)?                    □

     Name: ________________________________________________

     Signature: _____________________________________________

     Date: _________________________________________________

				
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