Instructions for Form 240A "Sample Reaffirmation Agreement" - Indiana

This document contains official instructions for Form 240A, Sample Reaffirmation Agreement - a form released and collected by the United States Bankruptcy Court for the Southern District of Indiana.

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SAMPLE REAFFIRMATION AGREEMENT

illustrating requirements for filing in a post-Bankruptcy Reform Act case

in the Southern District of Indiana

FILING THE REAFFIRMATION AGREEMENT:

Check that you answer the following questions correctly when the system prompts you:

Enter correct creditor name

Motion for Approval included in the PDF of the Reaffirmation Agreement? (yes or no)

Credit union? (yes or no)

Real property? (yes or no)

Undue hardship? (yes or no - take your answer from Parts C and D)

Attorney certification filed? (yes or no - only answer 'yes' if you have SIGNED part C)

DO NOT include a Proposed Order as part of the Reaffirmation Agreement - the Court

will prepare one if required.

SAMPLE REAFFIRMATION AGREEMENT

illustrating requirements for filing in a post-Bankruptcy Reform Act case

in the Southern District of Indiana

FILING THE REAFFIRMATION AGREEMENT:

Check that you answer the following questions correctly when the system prompts you:

Enter correct creditor name

Motion for Approval included in the PDF of the Reaffirmation Agreement? (yes or no)

Credit union? (yes or no)

Real property? (yes or no)

Undue hardship? (yes or no - take your answer from Parts C and D)

Attorney certification filed? (yes or no - only answer 'yes' if you have SIGNED part C)

DO NOT include a Proposed Order as part of the Reaffirmation Agreement - the Court

will prepare one if required.

Official form 240A dated 1/07 must be used. If an older version is used or a non-

official form, a deficiency notice may be issued by the Court.

Form 240A - Reaffirmation Agreement (1/07)

G Presumption of Undue Hardship

One of these two check

G No Presumption of Undue Hardship

boxes must be checked,

(Check box as directed in Part D: Debtor’s Statement

using the information from

in Support of Reaffirmation Agreement.)

Part D

UNITED STATES BANKRUPTCY COURT

Debtor's name(s) required

Case number required

____________________District of___________________

In re ____________________________,

Case No.__________________

Debtor

Chapter________________

REAFFIRMATION AGREEMENT

Parts A, B, and D must

[Indicate all documents included in this filing by checking each applicable box.]

be included. Part C is

optional. Part E must

G Part A: Disclosures, Instructions, and

G Part D: Debtor’s Statement in

be filed if: this is a pro

Notice to Debtor (pages 1 - 5)

Support of Reaffirmation Agreement

se case OR the debtor's

attorney has not signed

G Part B: Reaffirmation Agreement

G Part E: Motion for Court Approval

the Declaration in part C

OR Part C has not been

G Part C: Certification by Debtor’s Attorney

filed at all. Part E is not

required however if the

[Note: Complete Part E only if debtor was not represented by an attorney during

Reaffirmation

the course of negotiating this agreement. Note also: If you complete Part E, you must

Agreement is on real

prepare and file Form 240B - Order on Reaffirmation Agreement.]

property.

Creditor's name must be here

Name of Creditor:______________________________________________

If creditor is a credit

G [Check this box if] Creditor is a Credit Union as defined in §19(b)(1)(a)(iv) of the

union, this box

Federal Reserve Act

must be checked

PART A: DISCLOSURE STATEMENT, INSTRUCTIONS AND NOTICE TO DEBTOR

DISCLOSURE STATEMENT

Before Agreeing to Reaffirm a Debt, Review These Important Disclosures:

SUMMARY OF REAFFIRMATION AGREEMENT

This Summary is made pursuant to the requirements of the Bankruptcy Code.

AMOUNT REAFFIRMED

This amount must be filled in

The amount of debt you have agreed to reaffirm:

$_________________

The amount of debt you have agreed to reaffirm includes all fees and costs (if any) that have

accrued as of the date of this disclosure. Your credit agreement may obligate you to pay additional

amounts which may come due after the date of this disclosure. Consult your credit agreement.

The percentage rate must be stated in the

appropriate section of Part A

Form 240A - Reaffirmation Agreement (Cont.)

ANNUAL PERCENTAGE RATE

[The annual percentage rate can be disclosed in different ways, depending on the type of debt.]

a. If the debt is an extension of “credit” under an “open end credit plan,” as those terms

are defined in § 103 of the Truth in Lending Act, such as a credit card, the creditor may disclose

the annual percentage rate shown in (i) below or, to the extent this rate is not readily available or

not applicable, the simple interest rate shown in (ii) below, or both.

(i) The Annual Percentage Rate disclosed, or that would have been disclosed, to

the debtor in the most recent periodic statement prior to entering into the

reaffirmation agreement described in Part B below or, if no such periodic

statement was given to the debtor during the prior six months, the annual

percentage rate as it would have been so disclosed at the time of the disclosure

statement: ______%.

--- And/Or ---

(ii) The simple interest rate applicable to the amount reaffirmed as of the date

this disclosure statement is given to the debtor: __________%. If different

simple interest rates apply to different balances included in the amount

reaffirmed, the amount of each balance and the rate applicable to it are:

$ _________@ _________%;

$_________ @ _________%;

$_________ @ _________%.

b. If the debt is an extension of credit other than under than an open end credit plan, the

creditor may disclose the annual percentage rate shown in (I) below, or, to the extent this rate is

not readily available or not applicable, the simple interest rate shown in (ii) below, or both.

(i) The Annual Percentage Rate under §128(a)(4) of the Truth in Lending Act, as

disclosed to the debtor in the most recent disclosure statement given to the debtor

prior to entering into the reaffirmation agreement with respect to the debt or, if no

such disclosure statement was given to the debtor, the annual percentage rate as it

would have been so disclosed: _________%.

--- And/Or ---

(ii) The simple interest rate applicable to the amount reaffirmed as of the date

this disclosure statement is given to the debtor: __________%. If different

simple interest rates apply to different balances included in the amount

reaffirmed,

Form 240A - Reaffirmation Agreement (Cont.)

the amount of each balance and the rate applicable to it are:

$ _________@ _________%;

$_________ @ _________%;

$_________ @ _________%.

c. If the underlying debt transaction was disclosed as a variable rate transaction on the

most recent disclosure given under the Truth in Lending Act:

The interest rate on your loan may be a variable interest rate which changes from

time to time, so that the annual percentage rate disclosed here may be higher or

lower.

d. If the reaffirmed debt is secured by a security interest or lien, which has not been

waived or determined to be void by a final order of the court, the following items or types of

items of the debtor’s goods or property remain subject to such security interest or lien in

connection with the debt or debts being reaffirmed in the reaffirmation agreement described in

Part B.

Item or Type of Item

Original Purchase Price or Original Amount of Loan

There must be a description of collateral here IF

it's a secured loan

Optional---At the election of the creditor, a repayment schedule using one or a combination of

the following may be provided:

Repayment Schedule:

Your first payment in the amount of $___________ is due on _________(date), but the future

payment amount may be different. Consult your reaffirmation agreement or credit agreement, as

applicable.

— Or —

Your payment schedule will be: _________(number) payments in the amount of $___________

each, payable (monthly, annually, weekly, etc.) on the __________ (day) of each ____________

( week, month, etc.), unless altered later by mutual agreement in writing.

— Or —

A reasonably specific description of the debtor’s repayment obligations to the extent known by

the creditor or creditor’s representative.

Form 240A - Reaffirmation Agreement (Cont.)

2. INSTRUCTIONS AND NOTICE TO DEBTOR

These 7 'bullet

Reaffirming a debt is a serious financial decision. The law requires you to take certain

points' along

steps to make sure the decision is in your best interest. If these steps are not completed, the

with

reaffirmation agreement is not effective, even though you have signed it.

introductory

paragraph

1. Read the disclosures in this Part A carefully. Consider the decision to reaffirm

must be

included

carefully. Then, if you want to reaffirm, sign the reaffirmation agreement in Part B (or you may

use a separate agreement you and your creditor agree on).

2. Complete and sign Part D and be sure you can afford to make the payments you are

agreeing to make and have received a copy of the disclosure statement and a completed and

signed reaffirmation agreement.

3. If you were represented by an attorney during the negotiation of your reaffirmation

agreement, the attorney must have signed the certification in Part C.

4. If you were not represented by an attorney during the negotiation of your reaffirmation

agreement, you must have completed and signed Part E.

5. The original of this disclosure must be filed with the court by you or your creditor. If a

separate reaffirmation agreement (other than the one in Part B) has been signed, it must be

attached.

6. If the creditor is not a Credit Union and you were represented by an attorney during

the negotiation of your reaffirmation agreement, your reaffirmation agreement becomes effective

upon filing with the court unless the reaffirmation is presumed to be an undue hardship as

explained in Part D. If the creditor is a Credit Union and you were represented by an attorney

during the negotiation of your reaffirmation agreement, your reaffirmation agreement becomes

effective upon filing with the court.

7. If you were not represented by an attorney during the negotiation of your reaffirmation

agreement, it will not be effective unless the court approves it. The court will notify you and the

creditor of the hearing on your reaffirmation agreement. You must attend this hearing in

bankruptcy court where the judge will review your reaffirmation agreement. The bankruptcy

court must approve your reaffirmation agreement as consistent with your best interests, except

that no court approval is required if your reaffirmation agreement is for a consumer debt secured

by a mortgage, deed of trust, security deed, or other lien on your real property, like your home.

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