Form 240a - Reaffirmation Agreement ( Page 8
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9Form 240A - Reaffirmation Agreement (Cont.)
8
PART D: DEBTOR’S STATEMENT IN SUPPORT OF REAFFIRMATION AGREEMENT
[Read and complete sections 1 and 2, OR, if the creditor is a Credit Union and
the debtor is represented by an attorney, read section 3. Sign the appropriate
signature line(s) and date your signature. If you complete sections 1 and 2
and your income less monthly expenses does not leave enough to make the
payments under this reaffirmation agreement, check the box at the top of page
1 indicating “Presumption of Undue Hardship.” Otherwise, check the box at
the top of page 1 indicating “No Presumption of Undue Hardship”]
1. I believe this reaffirmation agreement will not impose an undue hardship on my
dependents or me. I can afford to make the payments on the reaffirmed debt because my
monthly income (take home pay plus any other income received) is $________, and my actual
current monthly expenses including monthly payments on post-bankruptcy debt and other
reaffirmation agreements total $________, leaving $________ to make the required payments
on this reaffirmed debt.
I understand that if my income less my monthly expenses does not leave enough to
make the payments, this reaffirmation agreement is presumed to be an undue hardship on me
and must be reviewed by the court. However, this presumption may be overcome if I explain
to the satisfaction of the court how I can afford to make the payments here:
.
(Use an additional page if needed for a full explanation.)
2. I received a copy of the Reaffirmation Disclosure Statement in Part A and a
completed and signed reaffirmation agreement.
Signed: ____________________________________
(Debtor)
_____________________________________
(Joint Debtor, if any)
Date: ___________________
— Or —
[If the creditor is a Credit Union and the debtor is represented by an attorney]
3. I believe this reaffirmation agreement is in my financial interest. I can afford to
make the payments on the reaffirmed debt. I received a copy of the Reaffirmation Disclosure
Statement in Part A and a completed and signed reaffirmation agreement.
Signed: ____________________________________
(Debtor)
_____________________________________
(Joint Debtor, if any)
Date: ___________________
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