Personal Insolvency Act 2012 (Prescribed Protective Certificate Personal Insolvency Arrangement Application Form) Regulations 2013

• Jurisdiction: Ireland

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 3rd September, 2013.

The Insolvency Service of Ireland, in exercise of the powers conferred on it by section 3 of the Personal Insolvency Act 2012 (No. 44 of 2012) (the “Act”), hereby makes the following regulations:

1. These Regulations may be cited as the Personal Insolvency Act 2012 (Prescribed Protective Certificate Personal Insolvency Arrangement Application Form) Regulations 2013.

2. The form set out in the Schedule to these Regulations is hereby prescribed for the purposes of section 93(2) of the Act.

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Schedule

APPLICATION FOR PROTECTIVE CERTIFICATE

(PERSONAL INSOLVENCY ARRANGEMENT)

*AN CHÚIRT CHUARDA

*[THE CIRCUIT COURT] *[THE HIGH COURT]

*THE PERSONAL INSOLVENCY ACT 2012

*[....] CIRCUIT *COUNTY OF [....]

IN THE MATTER OF AN APPLICATION UNDER SECTION 95 OF THE PERSONAL INSOLVENCY ACT 2012

AND IN THE MATTER OF [....................................................................]OF [....................................................................],

A DEBTOR

*I/*We ..............................................................................................................

of .................................................................................................................................

County of ...................................................................................................................

* and .............................................................................................................................

of ................................................................................................................................

County of ................................................................................................................

HEREBY APPLY for the making of an order for the issue under section 95 (2)(a) of the Personal Insolvency Act 2012 of a protective certificate.

Dated ............. 20 ........

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Important Information and Statements

1. Unless otherwise defined in this application form, terms used herein have the same meaning as under the Personal Insolvency Act 2012 (the “Act”).

2. This application form has been prescribed by the Insolvency Service for the purposes of Section 93(2) of the Act.

3. The Insolvency Service may request any further information it requires from a debtor (the “Debtor”), or personal insolvency practitioner and defer further consideration of the application until such information is furnished to the Insolvency Service. Failure to furnish such information, within 14 days or such longer period as the Insolvency Service may (at its discretion) permit, will mean that the application shall be deemed to have been withdrawn.

4. Where the personal insolvency practitioner becomes aware of any inaccuracy or omission in this application or any document accompanying this application, he or she is required under section 93(4) of the Act to inform the Insolvency Service of this fact as soon as practicable.

5. The Insolvency Service hereby agrees to the Debtor communicating with the Insolvency Service by electronic means for the purposes of any communication or notice required or permitted to be sent or given by the Debtor to the Insolvency Service, from time to time, in connection with this Act including for the purpose of any notice referred to in section 134 of the Act. Any such communication or notice should be sent to pia@isi.gov.ie.

6. Notwithstanding any agreement by the Debtor to receiving electronic communications and notices, there may be circumstances in which the Insolvency Service will send documents, information and other communications to the Debtor in hard copy rather than electronically, in which case the Insolvency Service reserves the right to do so, including for the purpose of giving the Debtor any notice referred to in section 134 of the Act.

7. This application may be withdrawn at any time prior to the issue of a protective certificate in accordance with section 93(3) of the Act.

8. This application shall be accompanied by the appropriate fee and the following documentation:

(a) a statement of the personal insolvency practitioner prepared under section 54 of the Act;

(b) the Debtor’s signed confirmation that he or she satisfies the eligibility criteria specified in section 91 of the Act;

(c) the declaration in writing of the Debtor referred to in section 91(1)(g) of the Act or in the alternative, the personal insolvency practitioner’s written confirmation as referred to in section 91(2) of the Act;

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(d) the Prescribed Financial Statement;

(e) the statutory declaration of the Debtor referred to in section 91(1)(e) of the Act;

(f) a schedule of creditors of the Debtor and the debts concerned, stating in relation to each such creditor the information specified in section 93(2)(e) of the Act;

(g) the Debtor’s written consent to the disclosure and processing of his or her personal data of the Debtor as specified in section 93(2)(f) of the Act;

(h) the Debtor’s written consent to the making of any enquiry under section 94 of the Act relating to the Debtor by the Insolvency Service;

(i) such other documentation as may be requested in this application.

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Application Form

APPLICATION QUESTIONS Is this an individual application or a joint application?If this is a joint application each Debtor must complete the “Debtor’s Details” sections. Individual Joint If an individual application, is it proposed that this application will be administered in common with one or more other Personal Insolvency Arrangements pursuant to Section 89 (4) of the Personal Insolvency Act 2012 ? If yes, provide ISI case reference number(s) for the relevant arrangement(s). Yes No Case Reference No(s).: Are the total liabilities of the Debtor as determined on the basis of the Prescribed Financial Statement completed by the Debtor in respect of this application in excess of €2,500,000? Yes No Has 25% or more of the Debtor’s debts (other than excluded debts) been incurred during the period of 6 months ending on the date of this application? Yes No Is the aggregate of the debts of the Debtor which are secured debts less than €3,000,000? Yes No If no, have all of the creditors who are secured creditors consented in writing so that the limit of €3,000,000 shall not apply?If yes, please provide a copy of the consent with this application. Yes No Is at least one of the creditors of the Debtor a secured creditor holding security over an interest in property (real or personal) of the Debtor situate in the State? Yes No

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(DEBTOR’S DETAILS sections to be completed by all debtors in the case of a joint application)

DEBTOR’S DETAILS — Initial Information Has the Debtor received advice from the personal insolvency...