AN CHÚIRT CHUARDA
THE CIRCUIT COURT
CIRCUIT COUNTY OF
Record number ......
IN THE MATTER OF PART 3, CHAPTER 4 OF THE PERSONAL INSOLVENCY ACT 2012
AND IN THE MATTER OF [........] OF [.......], A DEBTOR
Before Judge .......
(PERSONAL INSOLVENCY ARRANGEMENT)
1. Being satisfied that the above entitled proceedings may be brought in the Circuit Court for this Circuit because the total liabilities of the above named debtor determined on the basis of the Prescribed Financial Statement completed by the said debtor for the purpose of the proceedings do not exceed €2,500,000 and that the proceedings are brought in the Circuit of the Circuit Court in which
*the above-named debtor to whom the application relates was residing at the time of the making of the application or has resided within one year of the time of the making of the application
*the above-named debtor to whom the application relates had a place of business at the time of the making of the application or has had a place of business within one year of the time of the making of the application
2. Having considered:
(i) the application dated the .... 20 .... for the issue of a protective certificate in respect of the said debtor, furnished to the Court on ..... 20 .... by the Insolvency Service of Ireland
(ii) the certificate of the Insolvency Service of Ireland, having performed its functions under the Personal Insolvency Act 2012 in relation to the said application, that the application to the Insolvency Service of Ireland under section 93 of the Personal Insolvency Act 2012 on behalf of the said debtor is in order
(iii) copies of the supporting documentation for the application (other than the documents referred to in section 93(2)(f) and (g) of the Act)
*(iv) further *information *evidence provided to it
3. Being satisfied that the criteria specified in section 91 of the Personal Insolvency Act 2012 have been satisfied to the extent that the said criteria have not been disapplied by an order made under section 91(3) of the said Act
4. Being satisfied that the other relevant requirements relating to an application for the issue of a protective certificate have been met
hereby issues in accordance with section 95(2) of the Personal Insolvency Act 2012 a protective certificate in respect of the said debtor and in respect of the debts as set out hereunder:
Reference/Number (if any) as per Prescribed Financial Statement
Amount of the debt on the application date (€)
Creditor to whom debt is owed
Given by the Court on ....... 20 ....
*Delete where inapplicable
Form 52H inserted by SI 317 of 2013, effective 9 August 2013.