ABSTRACT
Debtor’s name ……………………………………………………………
Address ……………………………………………………………………..
Telephone ……………………… (day) …………………… (evening)
Age …………
Status: married/cohabiting/single/other (please specify) ………
Number of children ………… Ages of children …………
Other dependants …………
2 EMPLOYMENT STATUS
2.1 Employed
Employer’s name …………………………………………………………
Employer’s address ………………………………………………………
Job title ……………………………………………………………………..
Annual wage or salary …………………………………………………..
2.2 Self-employed
