Form B240/Oakland Revision 9/99 REAFFIRMATION AGREEMENT UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF CALIFORNIA Debtor' Name s Bankruptcy Case No. Chapter Creditor' Name and Address s Instructions: 1) Attach a copy of all court judgments, security agreements, and evidence of their perfection. 2) File all the documents by mailing them or delivering them to the Clerk of the Bankruptcy Court. NOTICE TO DEBTOR: This agreement gives up the protection of your bankruptcy discharge for this debt. As a result of this agreement, the creditor may be able to take your property or wages if you do not pay the agreed amounts. The creditor may also act to collect the debt in other ways. You may rescind (cancel) this agreement at any time before the bankruptcy court enters a discharge order or within 60 days after this agreement is filed with the court, whichever is later, by notifying the creditor that the agreement is canceled. You are not required to enter into this agreement by any law. It is not required by the Bankruptcy Code, by any other law, or by any contract (except another reaffirmation agreement made in accordance with Bankruptcy Code § 524 (c)). You are allowed to pay this debt without signing this agreement. If you do not sign this agreement and are later unwilling or unable to pay the full amount, the creditor will not be able to collect it from you. The creditor also will not be allowed to take your property to pay the debt unless the creditor has a lien on the property. If the creditor has a lien on your personal property, you may have a right to redeem the property and eliminate the lien by making a single payment to the creditor equal to the current value of the property, as agreed by the parties or determined by the court. If you cannot afford to redeem the property with one payment, the reaffirmation agreement allows you to pay for the merchandise in monthly installments as agreed upon by you and the creditor. American LegalNet, Inc. www.FormsWorkflow.com Form B240/Oakland Revision cont. 2 of 5 This agreement is not valid or binding unless it is filed with the clerk of the bankruptcy court. If you were not represented by an attorney during the negotiation of this reaffirmation agreement, the agreement cannot be enforced by the creditor unless 1) you have attended a reaffirmation hearing in the bankruptcy court, and 2) the agreement has been approved by the bankruptcy court. (Court approval is not required if this is a consumer debt secured by a mortgage or other lien on your real estate.) REAFFIRMATION AGREEMENT The debtor and creditor named above agree to reaffirm the debt described in ths agreement as follows. THE DEBT Total Amount of Debt When Case was Filed Total Amount of Debt Reaffirmed Above Total includes the following: Interest Accrued to Date of Agreement Attorney Fees Late Fees Other Expenses of Costs Relating to the Collection of this Debt (Describe) Annual Percentage Rate (APR) Amount of Monthly Payment Date Payments Start Total Number of Payments to be made Total of Payments if paid according to schedule Date Any Lien Is to Be Released if paid according to schedule $_____________ $__________ $__________ $__________ $__________ $__________ ___________% $__________ ___________ ___________ ___________ ___________ The debtor agrees that any and all remedies available to the creditor under the security agreement remain available. All additional Terms Agreed to by the Parties (if any): __________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com __________________________________________________________________________________ Form B240/Oakland Revision cont. 3 of 5 Payments on this debt [were][were not] in default on the date on which this bankruptcy case was filed. This agreement differs from the original agreement with the creditor as follows: __________________________________________________________________________________ __________________________________________________________________________________ CREDITOR' STATEMENT CONCERNING AGREEMENT AND SECURITY/COLLATERAL S (IF ANY) Description of Collateral. If applicable, list manufacturer, year and model: ______________________ __________________________________________________________________________________ Value Basis or Source for Valuation $_______________ ____________________________________________________ Current Location and Use of Collateral __________________________________________________ Expected Future Use of Collateral Check Applicable Boxes: ~ ~ Any lien described herein is valid and perfected. This agreement is part of a settlement of a dispute regarding the dischargeability of this debt under section 523 of the Bankruptcy Code (11 U.S.C. § 523) or any other dispute. The nature of dispute is _________________________________________________________________. ____________________________________________________ DEBTOR' STATEMENT OF S EFFECT OF AGREEMENT ON DEBTOR' FINANCES S My Monthly Income (take home pay plus any other income received) is $_____________. My current monthly expenses total $ ____________, not including any payment due under this agreement or any debt to be discharged in this bankruptcy case. American LegalNet, Inc. www.FormsWorkflow.com I believe this agreement [will][will not] impose an undue hardship on me or my dependents. Form B240/Oakland Revision cont. 4 of 5 DEBTOR' STATEMENT CONCERNING DECISION TO REAFFIRM S I agreed to reaffirm this debt because ______________________________________________ ____________________________________________________________________________ I believe this agreement is in my best interest because _________________________________ ____________________________________________________________________________ I [considered][did not consider] redeeming the collateral under section 722 of the Bankruptcy Code (11 U.S.C. § 722). I chose not to redeem because _____________________________________ ____________________________________________________________________________ I [was][was not] represented by an attorney during negotiations on this agreement. CERTIFICATION OF ATTACHMENTS Any documents which created and perfected the security interest or lien [are][are not] attached. [If documents are not attached: The documents which created and perfected the security interest or lien are not attached because _________________________________________________________________________