Sample documents
DOCUMENTS FOR THE REQUEST FOR DEBT RELIEF
LIST OF DATA FOR THE NEED FOR DEBT RELIEF
This list contains an overview of all the data that is necessary for submitting an application for debt relief via www.BankrotOnline.cz . You can note down the necessary information in the list, which you can then fill in directly in the online application for debt relief .
1. Applicant for debt relief (indicate the details of the person requesting debt relief)
Name:
Surname:
Title before the name:
Title after name:
Marital status:
Permanent residence
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
Mailing address
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
E-mail:
Personal identification number:
Birthdate:
Nationality:
2. Spouse of the applicant for debt relief (indicated if the application for debt relief will be submitted together with the spouse)
Name:
Surname:
Title before the name:
Title after name:
Marital status:
Permanent residence
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
Personal identification number:
Birthdate:
Nationality:
3. Family members of the applicant for debt relief (indicated if the applicant for debt relief lives in the same household with other persons or pays alimony to other persons)
Name:
Surname:
Permanent residence
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
Relationship to the applicant
Type of relationship (son/daughter – husband/wife – other person)
Does he live with the applicant in the same household (yes/no)?
Is the applicant obliged to support this person (yes/no)?
Has alimony been ordered for this person by the court (yes/no)?
Amount of alimony in CZK per month, if it has been imposed by the court
Number of the court decision on the determination of alimony, if it was issued
4. Property of the applicant for debt relief and his/her spouse, if the spouses are applying for debt relief together (all property except for personal items owned by the applicants shall be listed; for an indicative list of property, the Property overview form can also be used )
Type of property (property – real estate – bank account – building savings – life insurance – shares – other)
Description:
Quantity:
Year of acquisition:
Purchase price CZK:
Current price CZK:
Account number:
Current balance CZK:
Has the item been given as a pledge to the creditor (yes/no)
5. Debts of the applicant for debt relief and his/her spouse, if the spouses are applying for debt relief together (it is sufficient to indicate any two debts, it is not necessary to enter a complete list of the applicant’s debts. If the debts are already in execution, the data is not entered)
Creditor’s Name or Name:
ID number or date of birth of the creditor:
The registered office or residence of the creditor
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
The creditor is a relative of the applicant or the applicant’s spouse (yes/no)
Reason for incurring the debt (loan agreement – loan agreement – loan agreement – leasing agreement – credit card – overdraft – compensation for damages – payment assessment – court decision – other)
Contract number:
Closing date:
Due date of the last outstanding installment:
Date the applicant paid the last installment:
Current amount of debt:
Judgment number, if payment has already been imposed by court judgment:
Type of security, if the debt is secured by some property of the applicant (e.g. lien, lien, etc.)
6. Past income (indicate all income received by applicants in the last 12 months)
Type of income (salary – income from business – pension – maternity – parental allowance – unemployment benefit – sick pay – other – no income)
Name or name of the payer:
ID number or date of birth of the payer:
Place of residence or residence of the payer
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
Income drawing period from-to:
Amount of income for the specified period:
7. Future income (all income that applicants will receive after debt relief is approved)
Type of income (salary – income from business – pension – maternity – parental allowance – unemployment benefit – sick pay – other – no income)
Name or name of the payer:
ID number or date of birth of the payer:
Place of residence or residence of the payer
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
Amount of monthly income:
8. Receivables (Indicate persons who owe the applicant something. If no one owes the applicant, it will be left blank)
Borrower’s Name or Name:
ID number or date of birth of the borrower:
The domicile or residence of the borrower
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
Reason for incurring the debt (loan agreement – loan agreement – loan agreement – leasing agreement – credit card – overdraft – compensation for damages – payment assessment – court decision – other)
Contract number:
Closing date:
Due date:
Current amount of claim:
Number of the proceeding or judgment, if already issued or in progress:
9. Employees of the applicant (Indicate the employees of the applicant. If the applicant has no employees, it will be left blank)
Name:
Surname:
Permanent residence
State:
ZIP CODE:
Village:
Part of the village:
Street:
House number:
10. Other data
In this section, you can enter any other information or requirements that the applicant considers important for the processing of his request for debt relief.
.PROPERTY LIST
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(indicative list for later entering data into the online application for debt relief at www.BankrotOnline.cz )
Description (thing – real estate – bank account – building savings – life insurance – shares – other):
Quantity:
Year of acquisition:
Purchase price:
Current price or account balance:
Pawned (yes/no)?:
Description (thing – real estate – bank account – building savings – life insurance – shares – other):
Quantity:
Year of acquisition:
Purchase price:
Current price or account balance:
Pawned (yes/no)?:
Description (thing – real estate – bank account – building savings – life insurance – shares – other):
Quantity:
Year of acquisition:
Purchase price:
Current price or account balance:
Pawned (yes/no)?:
Description (thing – real estate – bank account – building savings – life insurance – shares – other):
Quantity:
Year of acquisition:
Purchase price:
Current price or account balance:
Pawned (yes/no)?:
INCOME DOCUMENTS
CONFIRMATION OF THE AMOUNT OF THE EMPLOYEE’S INCOME
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Employer
Name/Title:
Date of birth/ID:
Residence/Headquarters:
Representative:
Employee
Name:
Birthdate:
Residence:
1. Future gross monthly income *)
The employer confirms that the employee is employed by him in an employment relationship with anticipated future income from employment:
Type of relationship: employment relationship – agreement on work performed outside the employment relationship **)
Duration: for an indefinite period – for a definite period until: **)
Job title:
Gross income/month:
2. Net monthly income in the past 12 months *)
The employer confirms that the employee has achieved the following net income from employment in the employment relationship:
From:
To:
Type of relationship: employment relationship – agreement on work performed outside the employment relationship **)
Job title:
Total net income:
From:
To:
Type of relationship: employment relationship – agreement on work performed outside the employment relationship **)
Job title:
Total net income:
From:
To:
Type of relationship: employment relationship – agreement on work performed outside the employment relationship **)
Job title:
Total net income:
Employer
Date:
Signed by:
CONFIRMATION OF THE AMOUNT OF INCOME OTHER THAN EMPLOYMENT
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Payer
Name/Title:
Date of birth/ID:
Residence/Headquarters:
Representative:
Recipient
Name:
Birthdate:
Residence:
1. Future income *)
The Payer confirms that the Beneficiaries will pay the following amount:
Reason for payment:
Frequency: once – monthly – daily – other: **)
Duration: one-time – for an indefinite period – for a fixed period until: **)
Amount to be paid:
2. Elapsed income for the last 12 months *)
The payer confirms that he has paid the following amounts to the recipient:
From:
To:
Reason for payment:
Amount Paid:
From:
To:
Reason for payment:
Amount Paid:
From:
To:
Reason for payment:
Amount Paid:
Payer
Date:
Signed by:
CONTRACT OF DONATION
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This donation agreement (“Agreement”) is concluded in accordance with Act No. 89/2012 Coll., Civil Code, as amended, between the participants:
Donor
Name:
Birthdate:
Residence:
Gifted
Name:
Birthdate:
Residence:
1. The Donor undertakes to provide the Recipient with a monetary gift for the purpose specified in this Agreement, and the Recipient undertakes to accept and use this gift for the specified purpose.
2. The amount of the donation (“Donation”) is:
Amount donated:
3. The purpose of providing the Gift is to support the repayment of the Beneficiary’s debt in insolvency proceedings carried out in the form of debt relief through an installment plan, which has been or will be approved by the Beneficiary by the relevant insolvency court.
4. The Donor shall provide the Gift to the Recipient within 15 days from the date on which the final decision of the competent insolvency court approving the Recipient’s debt relief by fulfilling the repayment schedule is presented to him.
5. The donation will be provided by bank transfer of the amount to the Beneficiary’s account listed in the header of this Agreement or in cash to the Beneficiary’s hands or by depositing it to the account or to the hands of the relevant insolvency administrator for the payment of installments of the Beneficiary’s debt relief.
6. The use of the Gift by the Donee for a purpose other than that specified in this Agreement is considered ungrateful, and the Donor is entitled in such a case to withdraw from this Agreement and demand the return of the Gift in the amount that was used contrary to the purpose of this Agreement.
7. This Agreement becomes effective on the date of the acquisition of legal force of the decision of the relevant insolvency court on the approval of the Beneficiary’s debt relief by fulfilling the repayment schedule. In the event that the decision of the insolvency court is not issued within 6 months from the conclusion of this Agreement, this Agreement shall be cancelled.
Donor
Date:
Signed by:
Gifted
Date:
Signed by:
RETIREMENT AGREEMENT
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This pension contract (“contract”) is concluded in accordance with Act No. 89/2012 Coll., Civil Code, as amended, between the participants:
Payer
Name:
Birthdate:
Residence:
Recipient
Name:
Birthdate:
Residence:
1. The payer undertakes to pay the beneficiary regular cash benefits for the purpose specified in this contract, and the beneficiary undertakes to accept and use these benefits for the specified purpose.
2. The amount of the monthly allowance (“pension”) amounts to:
Monthly contribution:
3. The purpose of providing a pension is to repay the recipient’s debt in insolvency proceedings carried out in the form of debt relief, which has been or will be approved by the relevant insolvency court.
4. The first payment of the pension will be paid by the payer to the recipient within 5 days from the date on which he is presented with the decision of the relevant insolvency court on the determination of the bankruptcy of the recipient and the authorization to resolve the bankruptcy by discharge of debt. Each further pension payment is then due no later than the 5th day of the relevant following month. The payer can also pay more pension installments in advance.
5. All pension benefits will be paid by the payer to the account or to the hands of the relevant insolvency administrator, if so determined by the administrator or the insolvency court, otherwise to the account or to the hands of the recipient.
6. Pension benefits are provided exclusively to the recipient. The right to a pension or the claim for a payable pension benefit cannot be transferred to a third party without the prior written consent of the payer.
7. The payer is entitled to withdraw from this contract if the recipient uses any of the pension benefits for a purpose other than that specified in this contract.
8. This contract is concluded for a fixed period of time and will end either after the expiry of a period of 5 years from the legal effect of the decision of the insolvency court approving the relief of the beneficiary, or with the full discharge of the beneficiary in the relevant insolvency proceedings, or on the day of the acquisition of legal force of the decision of the relevant insolvency court on the cancellation or disapproval of the relief beneficiary, or after the expiration of a period of 6 months from the conclusion of the contract, if an insolvency petition with a proposal for debt relief is not filed within this period, depending on which of these facts occurs first.
9. This contract becomes effective on the date of its conclusion between the parties.
Payer
Date:
Signed by:
Recipient
Date:
Signed by:
INSOLVENCY PROCEEDINGS
Free downloadable debt relief application form. This form serves only as an overview, it cannot be submitted directly to the court by the debtor. According to the law, the completed application must be submitted through a lawyer or other qualified person.
GENERAL DOCUMENTS
FORM FOR WITHDRAWAL FROM AGREEMENT FOR THE PROVISION OF LEGAL SERVICES
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( This form is provided for the purpose of withdrawal of the consumer from the contract for the provision of legal services in the sense of Directive 2011/83/EU of the European Parliament and of the Council on consumer rights, which amends Directive of the Council 93/13/EEC and Directive of the European Parliament and of the Council 1999/44 /EC and repeals Council Directive 85/577/EEC and European Parliament and Council Directive 97/7/EC ) .
Čížek & Partners law firm sro
Železná 255/24
460 01 Liberec
Czech Republic
e-mail: info@bankrotonline.cz
Withdrawal from the contract for the provision of legal services regarding debt relief
I hereby announce that I am withdrawing from the contract for the provision of legal services negotiated with your law firm regarding the debt relief of the debtor:
Name and surname:
Birthdate:
Residence:
Signature:
( attach the signature only if the form is sent in writing )