Company And Financial Status



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If more space is needed for any item, continue under Section VII, Additional Data, Item 36 or attach separate sheet) PRIVACY ACT INFORMATION: The information you furnish on this form is almost always used to determine if you are eligible for waiver of a debt, for the acceptance of a compromise offer or for a payment plan.. TOTAL ASSETS SECTION VI - INSTALLMENT CONTRACTS AND OTHER DEBTS NOTE: Show below ALL debts which you are required to pay in regular monthly installments, such as a car, television, washing machine, payments to dealers, banks, finance companies, repayment of money borrowed for any purpose, doctor bills, hospital bills, etc..




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