hib_3070-1a2 (9/15) IMPORTANT! To upload this form in CM/ECF, and make this message disappear, you must "flatten" the file to lock in the information. "Print to PDF" or print to paper and scan it to make a PDF. Do not use "Save" or "Save As...." UNITED STATES BANKRUPTCY COURT DISTRICT OF HAWAII Debtor(s): Chapter 13 Case No. Debtor/Employee's SSN: XXX-XX- APPLICATION AND ORDER FOR EMPLOYER TO PAY FUNDS TO TRUSTEE EMPLOYEE Name and Address: Amended EMPLOYER Name and Address: Send payments to: Howard M.S. Hu, Trustee P.O. Box 29800 Honolulu, HI 96820-2200 Amount: $ To be paid every: (2 wks/month/etc.) The undersigned debtor agrees to submit wages or other income for periodic and direct payment to the Trustee. In accordance with this application, the above-named employer is directed, until further court order or notification that this case has been converted or dismissed, or that all plan payments have been completed, to deduct the amount stated above from the employee's income and to promptly remit it to the Trustee at the address above. Payments must identify the employee's name and bankruptcy case number. Payroll deductions such as current income tax withholding, social security, disability, insurance premiums, union dues, and mandatory retirement contributions, are not affected by this order and may be continued. The employer must notify the Trustee of any change in employment affecting compliance with this order. Dated: Signature of Debtor/Attorney: /s/ END OF ORDER Submitted by: American LegalNet, Inc. www.FormsWorkFlow.com