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PRACTICE DIRECTION – 15.5

AFFIDAVIT OF MEANS

　

1.    The attached form of affidavit of means should be used in applications for ancillary relief in matrimonial proceedings, with such modifications and additions as may be necessary.

2.   This Practice Direction shall come into effect on 22 October 1996.

　

IN THE DISTRICT COURT OF HONG KONG
NO.                      OF 19   

_______________

BETWEEN

Petitioner/1st Applicant +

AND

Respondent/2nd Applicant +

_______________

　

PETITIONER'S/RESPONDENT'S/1ST/2ND APPLICANT'S +

AFFIDAVIT/AFFIRMATION OF MEANS +

　

I, (name)

of (address)

make oath and say/do solemnly sincerely and truly affirm+ as follows:-

1. I am the abovenamed respondent*

petitioner*

1st/2nd applicant*
  +

2．I know that this is a solemn and important document, that I must be truthful and accurate and that if I knowingly distort or omit the truth I run the risk of imprisonment.

3．(a)      Occupation

                My present occupation is：-
I am employed*

Self-employed*

unemployed*

and have been since

retired*

and have been since

 
  (b)       If employed give the following details:-

I am employed on a casual basis*

                       on a fixed salary basis*

                       on a piece-rated basis*


                       otherwise *e.g. on commission (specify)

I have been so employed for

                                                                             Years                   Months

　
    My employer's name and address is:-

Name Address









If present job has lasted less than 2 years

   My previous occupation was:-

　



from                       to

 


   My former employer's name and address was:-

Name Address









            My monthly income was:-


$


      3．(c)     If self employed give the following details:-

I am a sole proprietor*

shareholder*

partner*

　       in the following business:-

Name of company Nature of business







　

（provide as exhibit 1, business accounts and tax assessments for the past two years）

     4.(a)  Income

My present basic/average + income per month is:-

$

       ( provide as exhibit 2, employer's certificate, payslip, tax return or other documentary evidence in support)

       In addition I receive:-

            $
Overtime average per month
(based on the last 12 months)

Income for a 13th month (average per month)

Bonus (average per month)

Commission average per month
(based on the last 12 months)

Tips average per month
(based on the last 12 months）

Housing allowance

Travel allowance

Education allowance

Entertainment allowance

Other allowances (specify)



These total or average per month
$

       (b)      Other income

                 Apart from the above I have/do not have + other income.

e.g. Rent, dividends, interest, other (specify)

Amount of other income per
month for past two years








（provide as exhibit 3, evidence of other income）

     5.      Residence

   I live at:- (address)
This unit is self or jointly owned*

Name of tenant
This unit is rented*


Name of registered tenant
This unit is a Public Housing Unit (PHU)*


Name of registered owner
This unit is Home Ownership Scheme (HOS)*


Otherwise* e.g. quarters, rent free (specify)

I live alone*

with others*

    Those with whom I live (if applicable) are:-

Name Relationship









     6.      Expenditure

   My monthly expenditure is or averages as follows:-

$
Rent
　
Mortgage instalments
　
Utilities (electricity gas rates telephone water)
　
Management fees
　
Food and household expenses
　
Meals out of home
　
Transport
　
Car expenses
　
Clothing
　
Medical
　
Entertainment presents holidays
　
Bank or other loan repayments
　
Credit card repayments
　
Tax
　
Insurance premia
　
School fees
　
Extra tuition fees
　
School books and stationery
　
Child's lunches and pocket money
　
Transport to school
　
Child minding fees
　
Child's clothing
　
Interim maintenance
　
Contribution to parents
　
Miscellaneous
　
Other (specify)
　
　
Total
$

（provide as exhibit 4, receipts accounts or other documentary evidence in support）

        7．    Dependant family members

         The following members of my family are supported by me:-

Name Relationship Age














      8.    (a)  Personal bank accounts

Details of my bank accounts that I now hold solely or jointly with others or in which I have or had any beneficial interest or I have held during the last two years are as follows:-

Bank & branch Name(s) of
account holder		 Account number Type of account Current balance
















$

         (b)   Credit card particulars

Credit card company Account holder Account number Current amount due












$

(provide as exhibit 5, bank and credit card statements for each account for the last two years)

   
      9.  Real property (flat, house, commercial property or land)

I own or have an interest in the following real property:-

Address:-

(provide as exhibit 6, documentary evidence of ownership)

  (provide as exhibit 6, documentary evidence of ownership)

The property is owned solely*

jointly*


(If joint) the names of co-owners and my share of ownership are:-

      Particulars of purchase

Date of purchase

    $
Downpayment

paid by

Mortgage/legal charge

name of lender

Personal loan

paid by

Legal decoration
and furniture costs

paid by

Total

$
My estimate of its present market value is:-
$
The amount presently outstanding on mortgage or charge is:-
$
The amount presently outstanding on personal loan is:-
$

(provide as exhibit 7, documentary evidence of mortgage or load)

   
    10.     Personal property (cars, boats, shares, securities, investments, jewellery, items of value)

    I own or have an interest in the following personal property:-

Description
of item		 Date acquired Present value Ownership
sole*            joint*		 If joint, name(s) of
co-owner(s)





$










$










$










$





(provide as exhibit 8, documentary evidence of ownership)

     11.    Pension entitlements

              I have*

do not have*

              the benefit of a pension scheme, provident fund, superannuation or contract gratuity from my employer.

Description of benefit Current value Date realizable Value at maturity



$






(provide as exhibit 9, documentary evidence of the benefit)

　
      12.     Insurance policies

      I have*

     do not have*

   the benefit of insurance policies as follows:-

Life policy*

Endowment policy*


Accident policy*

Medical insurance*

Other*(Specify)

(provide as exhibit 10, documentary evidence of the policy/policies and terms)


    13．   Personal debts

   Apart from debts referred to in paragraph 9, I owe the following debts:-

Amount presently owing When borrowed/ incurred To whom due Terms of repayment
$









(provide as exhibit 11, documentary evidence of the debts)
　

          14． The following information may be assistance to the Court in dealing with claims for maintenance or other relief
                    (include here statement of the assets you believe the other party to have)：-

    
      15． I do/do not + plan to remarry.

                I am/am not + cohabiting with anybody.

　　
      16． I make the following proposals as to how the present issues between the other party and me could be resolved:-

Sworn/Affirmed + at

this day of 19

before me:-

　

　

　
_______________________
+  delete whichever is not appropriate.
*  tick in the box that applies.