REFERRAL OF DEBTOR’S PETITION†REFERRAL OF DEBTOR’S PETITION†

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## REFERRAL OF DEBTOR’S PETITION† IN THE \[name of Court\] REGISTRY: \[name of Registry\] GENERAL DIVISION No. of \[year\] IN THE MATTER OF \[name of debtor or bankrupt estate\] \[name of applicant(s)\] Applicant(s) \[name of respondent(s)\] Respondent(s) The debtor \[name of debtor\] has presented a debtor’s petition to the Official Receiver. Creditor’s petition No. \[number\] of \[year\] is pending against a number of debtors or a partnership and includes this debtor. A copy of the debtor’s petition and statement of affairs is filed with this referral. The Court is asked to give a direction to accept or reject the petition. Date: \[signed, Official Receiver\] Official Receiver † The following information must appear at the foot of the first page of this referral. ```html <table cellspacing="0" cellpadding="0" style="width:361.5pt; border-collapse:collapse"><tbody><tr><td colspan="5" style="width:176.3pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Filed on behalf of (name and role of party)</td><td colspan="3" style="width:163.6pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom"></td></tr><tr><td colspan="5" style="width:176.3pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Prepared by (name of person/lawyer)</td><td colspan="3" style="width:163.6pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom"></td></tr><tr><td colspan="3" style="width:109.7pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Law firm (if applicable)</td><td colspan="5" style="width:230.2pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom"></td></tr><tr><td style="width:24.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Tel</td><td colspan="5" style="width:141.45pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom"></td><td style="width:22.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Fax</td><td style="width:129.4pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom"></td></tr><tr><td colspan="2" style="width:41.3pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Email</td><td colspan="6" style="width:298.6pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom"></td></tr><tr><td colspan="4" style="width:122.3pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">Address for service (include State and postcode)</td><td colspan="4" style="width:217.6pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"></td></tr><tr style="height:0pt"><td style="width:35.45pt"></td><td style="width:16.65pt"></td><td style="width:68.4pt"></td><td style="width:12.6pt"></td><td style="width:54pt"></td><td style="width:0.6pt"></td><td style="width:33.6pt"></td><td style="width:140.2pt"></td></tr></tbody></table> ```