FORM E

FORM E
In the
FINANCIAL
STATEMENT
st
Petitioner / 1 Applicant / Respondent / 2
District Court / High Court*
Case No
Always quote this
nd
Applicant*
Petitioner / 1st Applicant
Respondent / 2nd Applicant
and
Between
B ref.
Solicitor's
Solicitor's ref.
Please fill in this form fully and accurately. Where any box is not applicable write "N/A". You have a duty to
the court to give a full, frank and clear disclosure of all your financial and other relevant circumstances.
A failure to give full and accurate disclosure may result in any order the court makes being set aside and an
order for costs being made against you.
If you are found to have been deliberately untruthful, criminal proceedings for perjury may be taken against
you.
If there is not enough room on the form for any particular piece of information, you may continue on
an attached sheet of paper.
Attach documents to the form where they are specifically sought and you may attach other
documents where it is necessary to explain or clarify any of the information that you give.
This statement must be sworn or affirmed before a solicitor or a Commissioner for Oaths
before it is filed with the Court or sent to the other party
Important: You are recommended to obtain independent legal advice before completing this
form.
* delete as appropriate
INDEX
Part 1
Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
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Page
General Information …………………………………………………………..……. 2
Assets ………………………………………………………………………..……… 5
Liabilities ………………………………………………………………………..…. 12
Summaries of Assets and Liabilities ……………………………………………. 13
Income …………………………………………………………………………….. 14
Current Monthly Expenses ………………………………………………………. 16
Other Information …………………………………………………………………. 18
Orders Sought ……………………………………………………………………. 20
Schedule of Attachments ……………………………………………………..… 21
1
Part 1 General information
1.1
Full name
1.2
Date of birth
1.4
Occupation
1.4.1
I am employed *
Day
Month
Year
1.3
Day
Date of marriage
Month
Self-employed *
1.4.2
Unemployed *
and have been since
Day
Month
Year
Retired *
and have been since
Day
Month
Year
If employed give the following details:I am employed on a casual basis *
I have been so employed for
on a fixed salary basis *
on a piece-rated basis *
otherwise * (specify)
My employer's name and address is :Name
Address
If your present job has lasted less than 2 years
My previous occupation was:-
From : D/M/Y
To : D/M/Y
My former employer's name and address was:Name
Address
My previous monthly income was
HK$
* Tick in the box that applies.
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2
Years
Months
Year
1.4.3
If self-employed give the following details:I am a sole proprietor *
Partner *
Shareholder *
in the following business:Name of company
1.5
1.6
Day
Date of
separation
Nature and Address of business
Month
Year
Tick here
Petition
Date of the
if not applicable
Decree nisi/
Decree of Judicial Separation
Day
Month
Year
Day
Month
Year
Day
Month
Year
1.7
If you have
remarried,
state the date
1.8
If you intend to remarry, state the date, if known
1.9
Do you co-habit with another person ?
1.10
Do you intend to co-habit with someone within the next six months? Yes / No
1.11
Details of all children of the family
Day
Decree absolute
Month
Day
Month
Year
Year
Yes / No
Date of birth
Full names
1.12
Day
Month
With whom does the child live?
Give details of any physical or mental disability of yourself and the children
Yourself
Children
* Tick in the box that applies.
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Year
3
1.13
Give details of the present and proposed future educational arrangements for the children.
Present arrangements
Proposed future arrangements
1.14
Give details of any maintenance arrangement or maintenance orders made between the parties.
1.15
Give details of any other court cases between you and your spouse, whether in relation to money, property,
children, or anything else and attach copy orders.
Case No.
1.16
Court
Specify your present residence and its occupants and on what basis you occupy the residence.
I live at:- (address)
This is a self or jointly owned unit*
This is a rented unit*
Name of tenant
This is a Public Housing
Unit (PHU) *
Name of registered tenant
This is a Home
Ownership Scheme (HOS) unit*
Name of registered owner
Otherwise * e.g. quarters,
rent free (specify)
I live alone *
with others *
I live (where applicable) with the following persons:
Name
Relationship
* Tick in the box that applies.
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4
Assets
Part 2
2.1
Give details of your interest in the matrimonial home
Address
The property is owned solely *
jointly *
If joint, the names of co-owners are:My share of ownership or beneficial interest is:
Particulars of purchase
Date of purchase
D/M/Y
Downpayment
HK$
Paid by
Mortgage/legal charge
HK$
Name of lender
Other loans
HK$
Name of lender
Other Expenses
HK$
Paid by
Total
HK$
My estimate of its present market value is :-
HK$
My estimate is / is not based on a valuation report.
The amount presently outstanding on mortgage or charge is :-
HK$
The amount presently outstanding on other loans is :-
HK$
Attach a copy of documentary evidence of mortgage / other loans
* Tick in the box that applies.
NET value of your interest in the matrimonial home (A)
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5
HK$
2.2
Give details of all other landed properties in Hong Kong or elsewhere which you own or in which you have a beneficial
interest.
Address
The property is owned solely *
jointly *
If joint, the names of co-owners are:My share of ownership or beneficial interest is:
Particulars of purchase
Date of purchase
D/M/Y
Downpayment
HK$
Paid by
Mortgage/legal charge
HK$
Name of lender
Other loans
HK$
Name of lender
Other Expenses
HK$
Paid by
Total
HK$
My estimate of its present market value is :-
HK$
My estimate is / is not based on a valuation report.
The amount presently outstanding on mortgage or charge is :-
HK$
The amount presently outstanding on other loans is :-
HK$
Attach a copy of documentary evidence of mortgage / other loans.
* Tick in the box that applies.
TOTAL net value of the above (B)
(excluding the matrimonial home)
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6
HK$
2.3
Give details of all bank accounts in Hong Kong or elsewhere, which you hold or in which you have an interest
including those closed within the last 12 months. For joint accounts, state your interest and the names of the
account holders. Attach copies of your bank statements covering the last 12 months for each account. For fixed
or term deposits, attach copies of latest statements.
Name of bank
Type of
account
(e.g. current)
Account
number
Name of other
account holder
(if applicable)
Balance at the
date of this
form
TOTAL value of your interest in all accounts (C)
2.4
Total current
value of your
interest
HK$
Give details of all your shareholding / beneficial interest in private companies in Hong Kong or elsewhere. Attach
copies of the last 2 years’ audited / unaudited financial statements and any other documents on which you base
your valuation.
Name of Company
Date & Place of
Incorporation
The extent of your shareholding /
beneficial interest
TOTAL current value of all your shareholding / beneficial interest (D)
2.5
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List any directorships you hold or held in the last 24 months.
7
Your estimate of the current value of your
shareholding / beneficial interest
HK$
2.6
Give details of all other business interests in Hong Kong or elsewhere. Attach copies of the last 2 years’ audited /
unaudited financial statements and any other documents on which you base your valuation.
Name and nature of your
business
Your estimate of the current value of
your interest
The extent of your beneficial interest
TOTAL current value of your other business interests (E)
2.7
HK$
Give details of all stocks, bonds and other quoted securities and other investments in Hong Kong or elsewhere
which you hold or in which you have a beneficial interest. (Do not include dividend income in this paragraph).
Attach a copy of your latest statement for each account.
Name of Stocks / Bonds etc.
Securities
account(s)
The extent of
your beneficial
interest
Type
Current value
TOTAL value of your interest in all holdings (F)
2.8
HK$
Give details of all life insurance and endowment policies in Hong Kong or elsewhere which you hold or in which
you have an interest, including those that do not have a surrender value. If the policy is jointly owned, or has a
number of beneficiaries, identify the owners and beneficiaries.
Policy details including name
of company, policy type and
number
If policy is charged,
state in whose favour
and amount of charge
Maturity date
Day
Month
Year
Surrender
Value
TOTAL value of your interest in all policies (G)
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Total current value
of your interest
8
Total current
value of your
interest
HK$
2.9
Give details of all monies which are owed to you.
Brief description of debt
Balance
outstanding
Name of Debtor
Total current
value of the debt
including interest
Interest Owed
TOTAL value of your interest in ALL debts owed to you
TOTAL value of your interest in all debts owed to you (H)
2.10
Give details of valuable personal items including but not limited to cars, boats and jewellery.
Item
Purchase value
TOTAL value of your valuable personal items (I)
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HK$
9
Estimated current value
HK$
2.11
Give details of any other assets not listed above in Hong Kong or elsewhere (excluding pensions/mandatory
provident fund/gratuity) including but not limited to :
•
Share option scheme, stating the estimated net sale proceeds of the shares if the options were capable of
exercise now, and whether any taxes would be payable.
•
Trust interests (including interests under a discretionary trust), stating your estimate of the value of the
interest and when it is likely to become realisable. If you say it will never be realisable, or has no value,
give your reasons.
•
Specify also any asset that is likely to be received in the foreseeable future including any inheritance, any
assets held on your behalf by a third party and any assets not mentioned elsewhere in this form.
Type of asset
Value
TOTAL value of your other assets (J)
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10
Total net value of your
interest
HK$
2.12
Give details of your pension / Mandatory Provident Fund / gratuity interests.
Attach a copy of the valuation of your pension / Mandatory Provident Fund rights by the trustees or managers of
the scheme. Where the information is not available, give the estimated date when it will be available and attach
the letter to pension company or administrators from whom the information was sought. If you have more than
one pension plan or scheme, provide the information in respect of each one, continuing, if necessary, on a
separate piece of paper. If you have made Additional Voluntary Contributions or any Free Standing Additional
Voluntary Contributions to any plan or scheme, give the information separately if the benefits referable to such
contributions are separately recorded or paid.
I have *
do not have *
gratuity* from my employer.
Description of benefit
the benefit of a pension scheme*, mandatory provident fund*, superannuation* or contract
Current Value
Date Realizable
Value at maturity
HK$
HK$
* Tick in the box that applies.
TOTAL value of your pensions (K)
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11
Part 2
2.13
Liabilities
Give details of all other liabilities which you have not disclosed above. If you have credit cards, attach copies
of the latest credit card statements.
Liability
Amount
TOTAL value of your liabilities (L)
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12
HK$
Part 2
Summaries of Assets and Liabilities
Reference of the section
on this statement
Value
Net value of your interest in the matrimonial home
A
HK$
Total net value of all other landed properties (excluding the
matrimonial home)
B
HK$
Total value of your interest in all bank accounts
C
HK$
Total value of your shareholding / beneficial interest in all private
companies
D
HK$
Total value of your other business interests
E
HK$
Total value of your interest in all holdings (e.g. stocks)
F
HK$
Total value of your interest in all insurance policies
G
HK$
Total value of your interest in all debts owed to you
H
HK$
Total value of your valuable personal items
I
HK$
Total value of your other assets
J
HK$
Sub-total:
HK$
K
HK$
Total:
HK$
L
HK$
NET VALUE:
HK$
Total value of your pensions, if any
LESS: TOTAL value of your liabilities
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13
Part 3
3.1
Income
Earned Income: Give details of your income. Attach copies of proof of income for the last 3 months or contract of
employment, if any, and tax returns for the last 2 years.
My present basic / average* income per month is :-
In addition I receive :Overtime (average per month-based on the last 12 months)
Double pay (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 (average per month)
Travel allowance (average per month)
Education allowance (average per month)
Entertainment allowance (average per month)
Other allowances (specify) (average per month)
The total average per month
3.2
HK$
Additional Income: benefits, etc. Give details and the amount of all benefits in kind, perks, or other remuneration not
disclosed elsewhere, received in the last 12 months. Attach copies of proof of income for the last 3 months or contract
of employment, if any.
Nature of Income
Current amount per month
* Delete as appropriate.
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14
Average amount per month for
last 12 months
3.3
Income from any part-time employment, including all benefits, if any. Attach copies of proof of income for the last
3 months or contract of employment, if any.
Nature of Income
3.4
Current amount per month
Self-employed or partnership income: Give details of annual net profit or loss for the last 12 months. Attach
copies of the tax returns for the last 2 years.
Details of the last 12 months
Nature of income
Net profit/loss
3.5
Amount of your share of net profit/loss
Government allowances (including Comprehensive Social Security Assistance payments). Attach copies of latest
statements.
Nature of income
3.6
Current Amount
Other income. Give details of other income (e.g. rent, dividends, interest).
Nature of income
Amount of other income per month for last 12 months
Apart from the above I do not have any other income.
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Average amount per month for
last 12 months
15
Part 4 Current Monthly Expenses
4.1
General
Item
Amount
Rent
Mortgage instalments
Utilities (electricity, gas, rates, telephone & water)
Management fees
Food
Household expenses
Car expenses
Insurance premia
Domestic helper(s)
Others (specify)
HK$
Total monthly household expenses
Attach a copy of the latest rental receipt.
4.2
Personal
Item
Amount
Meals out of home
Transport
Clothing / Shoes
Personal grooming (including haircut and cosmetics)
Entertainment / presents
Holidays
Medical / Dental
Tax
Insurance premia
Interim maintenance
Contribution to parents
Dependent family members
Others (specify)
HK$
Total monthly personal expenses
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16
4.3
Children
Item
Amount
School fees
Extra tuition fees
School books and stationery
Transport to school (including school bus)
Medical / Dental
Entertainment / presents
Holidays
Clothing / Shoes
Insurance premia
Lunches and pocket money
Other Transport
Child-minding fees
Uniform
Others (specify)
Total monthly expenses for children
HK$
Total Monthly Expenses
(4.1 + 4.2 + 4.3)
4.4
HK$
Anticipated Future Expenses
Give details of any anticipated substantial changes in the above expenses in the foreseeable future.
Item
50536
General / Yourself /
Children
Anticipated Date of
change
17
Amount after
the change
Amount of
Increase / Decrease
Part 5 Other Information
5.1
State whether there has been any significant change in your assets during the last 36 months, including any assets
held outside Hong Kong.
5.2
Conduct by either party will only be taken into account in exceptional circumstances. If you feel it should be
taken into account in your case, identify the nature of such conduct.
5.3
Give brief details of the standard of living enjoyed by you and your spouse during the marriage (e.g. size of home,
clubs, holidays per year, domestic helper(s)).
5.4
Give brief details of the standard of living enjoyed by the children and the manner in which they were being
and in which you and your spouse expected them to be educated.
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18
5.5
Give details of any other circumstances which you consider could significantly affect the extent of the
financial provision to be made by or for you or for any child of the family, including but not limited to
earning capacity, disability, inheritance prospects, redundancy, cohabitation plans, and any contingent
liabilities.
5.6
If you have remarried (or intend to) or are cohabiting with another person (or intend to) give brief details,
so far as they are known to you, of his or her income and assets.
Monthly Income
Nature of income
Total income
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Assets
Item
Monthly Income
Total assets
HK$
19
Value
(if known)
HK$
Part 6 Orders Sought
6.1
If you are able to at this stage, specify what kind of orders you are asking the court to make.
6.2
If you are seeking a transfer, settlement or sale of any property, identify the property in question.
6.3
If you are seeking an avoidance of disposition order, identify the property to which the disposition relates and
the person or body in whose favour the disposition is alleged to have been made.
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20
Part 7 Schedule of Attachments
Please indicate with a tick in
corresponding numbers.
the attachments to your Financial Statement and number them with the
Part 2
2.1
Matrimonial Home:
Copy of latest statement of mortgage / other loans
2.2
Other landed properties:
Copy of latest statement of mortgage / other loans
2.3
Copies of bank statements of the last 12 months for each account
and copies of latest statements for fixed or term deposits
2.4
Copies of the last 2 years’ audited / unaudited financial statements of your
private companies and any other documents on which valuation is based
2.6
Copies of the last 2 years’ audited / unaudited financial statements in respect of
all other business interest and any other documents on which valuation is based
2.7
Copies of latest statements for each securities account
2.12
Copy of the valuation of pension/Mandatory Provident Fund rights by the
trustees or managers of the scheme
2.13
Copies of latest credit card statement for each credit card
Part 3
3.1
Copies of proof of earned income for the last 3 months or contract of
employment if any, & tax returns for last 2 years
3.2
Copies of proof of additional income for the last 3 months or contract of
employment if any.
3.3
Copies of proof of income from part-time employment for the last 3 months
or contract of employment if any.
3.4
Copies of tax returns for the last 2 years in case of self-employment/partnership
3.5
Copies of latest statements of government allowances
Part 4
4.1
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Copy of latest rental receipt
21
Sworn / Affirmed* confirmation of the information
I
of
st
(the above named Petitioner / 1 Applicant
nd
/ Respondent / 2 Applicant*)
(Residential address)
Signed
swear by Almighty God / solemnly, sincerely and
truly declare and affirm* that the contents of this my
affidavit/affirmation* are true and confirm that the
information given above is a full, frank, clear and
accurate disclosure of my financial and other relevant
circumstances.
Dated
Sworn/ Affirmed* by the above named [Petitioner] [1st Applicant] [Respondent] [2nd Applicant]* at
on
before me
Signed
Name
A Solicitor / Commissioner* for Oaths duly appointed to take Affidavits
* delete as appropriate
Address all communications to the Chief Judicial Clerk or if the matter is in the High Court, the Clerk of Court and
quote the case number from page 1. If you do not quote this number, your correspondence may be returned.
Chief Judicial Clerk
Family Court Registry
Wanchai Law Courts
Wanchai Tower
12 Harbour Road, Hong Kong
OR
If the matter is in the High Court
The Clerk of Court
High Court of Hong Kong
Ground Floor, High Court Building
38 Queensway, Hong Kong
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22
Explanatory Note to Financial Statement
1.
The court has been asked to consider the parties’ financial position and to make appropriate orders for financial provision for
the parties and for any relevant children of your family.
2.
It cannot perform this task unless both parties fully co-operate with each other and with the court by making full and frank
disclosure of their income and financial resources.
3.
The Financial Statement is a comprehensive document which both parties are required to complete to provide relevant
information to the court.
4.
As you will have noticed it is quite lengthy, and a substantial amount of information needs to be provided. The document has
been designed to be as clear and straightforward as possible. If you have a lawyer he or she will assist you in its preparation.
5.
If you are unrepresented the Financial Statement has been set out so that it can be filled in by a lay person.
6.
Although it requires careful and patient reading it is an uncomplicated Financial Statement despite the number of questions that
it contains. Answer all questions as truthfully and as fully as you can.
7.
Some questions may not relate to your situation in which case you will not need to answer them. For those questions that do
not relate to you state “Not applicable” to show that you have read the question, or put a line through the box provided for the answer.
8.
This is an important matter and it is in your best interests to complete the Financial Statement as fully as possible. Allow
yourself sufficient time to fill it in properly and within the time limit set by the court.
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23