Self employment affidavit

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					IN THE MATTER of                     the Insolvency Act 1967 / 2006                                                                                           “A”


AND                                                                                                                 IN THE MATTER of            the Insolvency Act 1967 / 2006


IN THE MATTER of                     an Application for Consent to be Self Employed                                 AND


                                                                                                                    IN THE MATTER of            an Application for Consent to be Self Employed
                      AFFIDAVIT VERIFYING APPLICATION FOR CONSENT
                                  TO BE SELF EMPLOYED

                                                                                                                    I,_____________________________________of ______________________________
I, ____________________________of _______________________________,
                                                                                                                    swear:
bankrupt, swear:
                                                                                                                    1.       That I was adjudicated bankrupt on _____________ in the High Court at

THAT I believe the information and statements contained in the Application for Consent                                       _______________________________________________________________
to be Self Employed (a copy of which is attached and marked with a letter “A”) to be
                                                                                                                    2.       I seek the Consent of the Official Assignee for leave to enter business on my
true and correct.
                                                                                                                             own account.

                                                                                                                    3.       My present employment status is ___________________________________
Signed       ______________________________________________________________
                                                                                                                    4.       I wish to be self employed for the following reasons: ____________________

                                                                                                                             _______________________________________________________________
Sworn at .............................................this ......... day of ............................ 20......            _______________________________________________________________
before me:                                                                                                          5.       The proposed business is a new business/existing business.

                                                                                                                    6.       The nature of the proposed business is _______________________________
____________________________________________
                                                                                                                    7.       My bankruptcy resulted from a business failure/not related to a business
Name:
A Solicitor of the High Court of New Zealand                                                                                 failure.
Justice of the Peace
                                                                                                                    8.       The causes of my bankruptcy were: _________________________________

                                                                                                                    ______________________________________________________________________
9.    My duties and responsibilities in the proposed business will be:____________       17.        The financial supervisor (accountant) will be: __________________________

      _______________________________________________________________                               and their role and powers will be: ___________________________________

      _______________________________________________________________                               _______________________________________________________________

                                                                                                    _______________________________________________________________
10.   The plant and equipment required for the business are: __________________
                                                                                         18.        That my accountant will submit trading statements to the Official Assignee on
      _______________________________________________________________
                                                                                                    a two monthly basis.
11.   I currently have the necessary plant and equipment on hand/The funding for
                                                                                         19.        Twelve month/two year/three year budget and cash flow projections have
      the plant and equipment will come from ______________________________
                                                                                                    been prepared.
12.   There will be no other staff/there will be _____ staff employed (state number)
                                                                                         20.        That contributions to my current bankruptcy will be available.

13.   The business will operate from ____________________________________
                                                                                         21.        The benefit to my creditors in allowing this application is _________________
      (ie. home or leased premises. For leased premises, full details of the proposed
                                                                                                    _______________________________________________________________
      lease must be provided.)
                                                                                                    _______________________________________________________________
14.   The business will operate a bank account at ___________________________
                                                                                         22.        The following information is also supplied in support of this application (if
      _______________________________________________________________                               applicable): _____________________________________________________

15.   The capital that I will put into the business will be ______________________                  _______________________________________________________________

      and/or the capital that another person will put into the business will be (state
                                                                                         DATED this ........... day of ....................................................... 20.....
      name and amount) _______________________________________________

16.   The specific provisions that are proposed to ensure that all taxes and             Signed: __________________________________

      regulatory requirements are met are: ________________________________
                                                                                         Witnessed:             ___________________________________
      _______________________________________________________________                    Name:

      _______________________________________________________________                    A Solicitor of the High Court of New Zealand
                                                                                         Justice of the Peace