Family Court Rules 2002

Form P(R) 1 Affidavit of assets and liabilities

r 398

Property (Relationships) Act 1976

(Front page—Form G 1)

I, [full name, address, occupation], swear/affirm* that—

1

My assets and liabilities are as described in paragraphs 4 to 9.

2

I am aware that making a false statement in this affidavit could result in any order of the court being set aside and criminal proceedings being brought against me.

*Select one.
Assets
3

I have no interest in any assets other than the assets described in paragraph 4.

4

My assets are as follows:

(a)

Family home or homestead

Location:

LINZ title reference:

All names on title:

My legal and beneficial interest in the property:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

(b)

Land and buildings

Location:

LINZ title reference:

All names on title:

My legal and beneficial interest in the property:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If you claim this as your separate property, explain why]

(c)

Household chattels

Location:

Share owned by me:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

Chattels claimed as separate property: [list chattels and explain why you claim them as separate property]

(d)

Superannuation

Name of owner of scheme or schemes:

Policy name and/or number:

Proportion of value claimed as separate property:

How proportion was calculated:

Value at start of marriage, civil union, or de facto relationship:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

(e)

KiwiSaver

Name of owner of scheme or schemes:

Policy name and/or number:

Proportion of value claimed as separate property:

How proportion was calculated:

Value at start of marriage, civil union, or de facto relationship:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

(f)

Money in bank accounts

Bank:

Name of account:

Account No:

Nobody else has an interest in this account/Another person has or other persons have an interest in this account*

*Select one.

Share of this account owned by me:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If this account is claimed as your separate property, explain why]

(g)

Cash in excess of $300

Location:

Currency held in:

Amount:

Nobody else has an interest in this cash/Another person has or other persons have an interest in this cash*

*Select one.

Share of this cash owned by me:

[If this cash is claimed as your separate property, explain why]

(h)

Details of any money owed to me

Name and address of borrower:

Amount borrowed:

Balance outstanding at end of marriage, civil union, or de facto relationship:

Balance outstanding at date of affidavit:

Nobody else has an interest in this amount/Another person has or other persons have an interest in this amount*

*Select one.

Share of this amount owed to me:

[If this amount is claimed as your separate property, explain why]

(i)

Government stock, debentures, or bonds

Name of investment:

Type of investment:

Size of holding:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

Name of any other account holder (if applicable):

Value of my interest at date of affidavit:

Value of my interest at end of marriage, civil union, or de facto relationship:

[If this investment is claimed as your separate property, explain why]

(j)

Company shares, debentures, or bonds

Name of investment:

Type of investment:

Size of holding:

Current value:

Name of any other account holder (if applicable):

Value of my interest at end of marriage, civil union, or de facto relationship:

Value of my interest at date of affidavit:

[If this investment is claimed as your separate property, explain why]

(k)

Plant and machinery

Description:

Share owned by me:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If this is claimed as your separate property, explain why]

(l)

Livestock

Description:

Share owned by me:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If livestock is claimed as your separate property, explain why]

(m)

Interest in business, partnership, stock-in-trade, or venture

Name of business/partnership/venture:

Nature of the business and principal sources of income for the venture and for me: [briefly describe]

I am a [specify whether you are a sole trader, partner, or shareholder].

Extent of my interest in the business: [specify interest if a partner or shareholder].

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

Date at which next annual financial statements for the business, partnership, or venture will be available:

[If this interest is claimed as your separate property, explain why]

(n)

Motor vehicles

Description:

Registered owner:

Share owned by me:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If motor vehicle is claimed as your separate property, explain why]

(o)

Life insurance policy

Owner of policy:

Life assured:

Insurance company:

Policy number:

Share owned by me:

Value at start of marriage, civil union, or de facto relationship:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

Proportion of value claimed as relationship property and proportion of value claimed as separate property:

How proportion was calculated:

(p)

Insurance claims outstanding for events that occurred during relationship

Owner of policy:

Item/property insured:

Insurance company:

Policy number:

Amount of claim:

Date and amount of payment of claim:

Share owned by me:

Proportion of value claimed as relationship property and proportion of value claimed as separate property:

How proportion was calculated:

(q)

Claims for compensation or damages outstanding for events that occurred during relationship

Description:

Amount of claim:

Date and amount of payment of claim:

Share owned by me:

Proportion of value claimed as relationship property and proportion of value claimed as separate property:

How proportion was calculated:

(r)

Interest in estate

Description (including whether the interest is a legal or beneficial interest):

My share:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If claimed as your separate property, explain why]

(s)

Interest in trust

Description (including whether the interest is a legal or beneficial interest):

My share:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If claimed as your separate property, explain why]

(t)

Accumulated benefits due to me as an employee or customer

Description:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If claimed as your separate property, explain why]

(u)

Tax refund due to me at end of relationship

Amount due:

Date and amount paid or credited:

(v)

Any other property or asset not specified above that is, or could be, the subject of an order in the proceedings

Description:

Share owned by me:

Value at end of marriage, civil union, or de facto relationship:

Value at date of affidavit:

[If claimed as your separate property, explain why]

5

Valuations of items described in paragraph 4(a), (b), (c), (d), (k), (l), and (n) are attached and marked A, B, C, D, E, F, and G respectively.

6

The proof of deposits or holdings of items in paragraph 4(e), (f), (h), (i), and (j) are attached and marked H, I, J, K, and L respectively.

7

The most recent annual financial statements for the items described in paragraph 4(m) are attached and marked M.

8

Copies of the trust deeds for items in paragraph 4(s) are attached and marked N.

Liabilities
9

My liabilities are as follows:

(a)

Mortgages secured over family home

Mortgagee:

Mortgagor:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(b)

Mortgages secured over any other land or buildings

Property:

Mortgagee:

Mortgagor:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(c)

Bank overdrafts or term loans

Account in the name of:

Bank:

Account No:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(d)

Loans secured over chattels, plant, machinery, or livestock

Property:

Name of borrower:

Lender:

Account No:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(e)

Hire purchase loans

Goods:

Name of borrower:

Lender:

Account No:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(f)

Credit card debt

Name of account:

Bank:

Account No:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(g)

Other loans

Lender:

Borrower:

Reference number (if any):

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(h)

Money owed to Inland Revenue Department

Type of tax owed:

Person liable:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(i)

Unsecured debts

Lender:

Evidence of debt (if any):

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

(j)

Any other liabilities not falling within any of the preceding paragraphs

Nature of liability:

Evidence of liability (if any):

To whom owing:

Amount owing at end of marriage, civil union, or de facto relationship:

Amount owing at date of affidavit:

10

Statements verifying balances are attached and marked [insert numbers for each attachment].

Income
11

Since the end of my marriage, civil union, or de facto relationship, I have not earned or received any income other than as set out below from an asset described in paragraph 4 or from other sources:

Source:

Amount:

Capital payments
12

Since the end of my marriage, civil union, or de facto relationship, I have made the following capital payments to an asset described in paragraph 4:

Asset:

Amount paid:

Assets disposed of
13

Since the end of my marriage, civil union, or de facto relationship, I have not sold or otherwise disposed of (or agreed to sell or dispose of) any asset in which I had an interest at the date on which my marriage, civil union, or de facto relationship ended, other than the following:

Asset:

Date:

Amount received or to be received:

Disposition of amount:

Assets acquired
14

Since the end of my marriage, civil union, or de facto relationship, I have not acquired or agreed to acquire any assets using relationship property, other than the following:

Asset:

Mode of acquisition:

Amount paid or to be paid:

Value at date of affidavit:

Signature of deponent:

Sworn/Affirmed* at [place, date]

*Select one.

Before me: [name, signature]

(a solicitor of the High Court/Registrar/Justice of the Peace*)

*Select one.

Schedule 8 form P(R) 1: replaced, on 31 March 2014, by rule 45 of the Family Courts Amendment Rules (No 2) 2014 (LI 2014/4).