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Sheriff Court ..........

APPLICATION FOR TIME ORDER


(1)  .......... .......... .......... APPLICANT	.......... 19 .......... (court reference no.)
(2)  .......... .......... .......... RESPONDENT



    (1)  insert your name and address

    (2)  insert full name and address of the person against whom the order is sought

The applicant asks the court to make
 * (a) a time order under section 129 of the Consumer Credit Act 1974;
 * (b) an order in terms of section (3)           of the Consumer Credit Act 1974

*delete as appropriate

    (3)  insert the section number of the Consumer Credit Act 1974 under which any ancillary order is craved

My proposal for payment of the arrears and future instalments is £.......... per week/month.

No time to pay direction or time to pay order has been made in relation to this debt.

I have breached the terms of the agreement, as follows—

..........

..........

..........

My proposals for remedying the breach(es) are as follows—

..........

..........

..........

*delete whichever box not appropriate

The ancillary order(s) sought in addition to the time order are sought for the following reasons (4)..........

..........

..........

..........

*delete box if not appropriate

    (4)  insert here the reasons why you have sought any ancillary order in addition to a time order

    i.    Date of agreement .......... and reference number ..........(5)

* A copy of the agreement is attached.

    ii.    Names and addresses of other parties to the agreement

..........

..........

    iii.    Name and address of person (if any) who acted as surety

..........

..........

    iv.    Reason why respondent is now creditor (applies where agreement transferred to another company)

..........

..........

    v.    Place where agreement signed (eg the shop where agreement signed, include name and address)

..........

    vi.    Details of payment arrangements

    a.  The agreement is to pay by instalments of £.......... per week/ month *

    b.  The unpaid balance is £........../I do not know the unpaid balance*

    c.  I am £.......... in arrears/I do not know the amount of arrears*

    vii.    The respondent served on me a—

default notice/section 76(1) notice/section 98(1) notice*

A copy of the notice is/is not* attached to this application.

    (1)  Attach a copy of the agreement to the application form if you have retained it or delete

insert details of the agreement where known—refer to your copy of the agreement if you have retained it

*delete as appropriate

Signed .......... APPLICANT/SOLICITOR FOR APPLICANT

Date ..........

TO HELP THE COURT PLEASE PROVIDE DETAILS OF YOUR FINANCIAL POSITION IN THE BOXES BELOW
(If necessary attach a separate sheet)

INCOME
My income is: (give average weekly figures, after deductions)
Pay (include overtime, bonuses etc)	£
Pensions	£
State Benefits	£
Other income	£
Total	£

EXPENDITURE
My expenditure is: (give average weekly figures)
Rent/Mortgage	£
Council Tax	£
Heating/Light	£
Food	£
Payments for credit cards hire purchase etc	£
Other payments (specify)	£
Total	£

DEPENDANTS
List the names and ages of members of the household who are financially dependent on you.