IN THE FEDERAL CIRCUIT AND
FAMILY COURT OF AUSTRALIA
(insert location of Registry) REGISTRY
No:  		of 2	
in the matter of 	
	
(Name of debtor)

	Applicant Creditor

		
	Respondent Debtor

AFFIDAVIT OF DEBT
Subrule 4.06(4)
Federal Circuit and Family Court of Australia (Division 2) (Bankruptcy) Rules 2021

On 	(date),   I, 	
(insert name, address and occupation)
of	

say on oath/declare and affirm (delete whichever is inapplicable) – 
1. I am the applicant creditor. 
	or
2. I am the (insert position held with applicant creditor) of the applicant creditor and as such have access to the books and records of the applicant creditor. I am duly authorised to swear this affidavit on behalf of the applicant.
3. Each debt on which the applicant creditor relies is still owing. 
(Note: The following signature block bounded by two horizontal lines must appear at the foot of the first page of the document. After completion of the document, please cut and paste the signature block as required so that it is correctly located.)
Filed by the Applicant
Name:							DX:
Address for service:					Telephone:
Facsimile:							Ref:
________________________________________________________________
SWORN/AFFIRMED (delete whichever is inapplicable) at (insert name of place):
…………………………………………………..				……………………………………………..
Before me: (witness signs here)				(deponent signs here)
	        (Justice of the Peace)