page 1 Application for cancellation Private individual and sole proprietorship

What you need to know before you apply for debt cancellation

Before you complete the form, it is important that you You must use this form if you are applying for debt can- read this guide concerning: cellation as a private individual or sole proprietorship. If • What applying for debt cancellation entails you are applying as a company, association, self-gover- • How to apply for debt cancellation ning institution or foundation, you must use form 51.068, which you can find atgaeldst.dk/blanket51068 .

What does applying for debt cancellation entail?

When you apply for debt cancellation, you are apply- you knew that you could not pay off. ing for cancellation or reduction of your debt to public authorities. This means that you are applying for cancel- You have debt arising from penalties or compensation lation of all or part of your debt. This is the case if a large part of your debt has arisen as a consequence of criminal offences or circumstances for When you apply for debt cancellation, you are apply- which you have to pay compensation. ing for cancellation or reduction of your debt to public authorities. This means that you are applying for cancel- You have failed to pay off your debt lation of all or part of your debt. This is the case if you have not paid off your debt when there has been an opportunity for you to do so. Can your debt be cancelled? We may grant you full or partial debt cancellation if: You have arranged your finances in the expectation of • Your debt is so large that you would not be able to debt cancellation pay it off in the coming years This is the case if you have e.g. acted in the expectation • Your financial situation will be permanently impro- of debt cancellation by concealing assets or paying off ved by debt cancellation all other debt than the debt you expect to be cancelled. • Your specific social circumstances or state of health, such as serious physical or mental illness, You have incurred new debt after you applied for debt make debt cancellation particularly advisable. cancellation This is the case if you have e.g. not paid your bills to This means that you need to be hopelessly in debt and public authorities in due time. unable to pay off your debt. We assess this by compa- ring the size of your debt with your ability to pay it off. There are other grounds for refusal of debt cancellation There may be other circumstances that make you ineli- When is it not possible for your debt to be cancelled? gible for debt cancellation. Your debt will not normally be cancelled if you and your financial situation fulfil one or more of the follow- If your debt is considered to be old, in a few individual ing grounds for refusal: cases your debt may be cancelled even though some of your circumstances would indicate refusal of debt can- Your financial situation remains unresolved cellation. We typically consider debt to be old if it was This is the case if you are e.g. unemployed, receive taken out more than six to eight years ago. temporary social assistance such as cash benefits, or are a student. Is a large part of your debt to private creditors? If a large part of your debt is to e.g. your or a You have been financially reckless finance company, you should apply for debt reschedu- This is the case if you have e.g. established a large debt ling under the probate court. You can read more about for personal spending, or taken out a lot of debt which the rules at domstol.dk. 03 . 1 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 2

How to apply for debt cancellation

• You must complete all relevant fields in the form. You must pay off your debt while we process your • You must document that you are unable to pay application your debt. We will continue the collection of your debt while we • You must complete the form as a solemn decla- process your application. This means that we can e.g. ration. levy execution, or set off and deduct part of your income to pay off your debt. Your case will be decided more quickly if you com- plete the entire form at once and submit all documen- Even though you have applied for debt cancellation, tation. you must therefore continue to pay off your debt to public authorities. If you have agreed a repayment You must document all fields in the form arrangement with us, you will still have to pay into You must document all your expenses it. This will also be the case if we extend the deadline You can e.g. include payment summaries from your for processing your application for debt cancellation. bank, copies of your rental contract or copies of bills. How to submit your application You must document all your income Download the form onto your computer before you You must provide documentation of all of your start to complete it. Remember to save changes along income during the last three months. The documen- the way, to ensure that your information is not lost. tation may include copies of payslips, pay- ments or account statements. Online application You can send your application form with appendices If you have assets, such as a house or shares, you to the Debt Collection Agency at gaeldst.dk/contact/ must document their value. eng. Select ‘Log on to send a messege’ under ‘Indi- viduals’. In Tast-Selv, select ‘Kontakt’, ‘Skriv til os’, How do I document other circumstances? ‘Betaling og gæld’, ’Gæld og restance’ and ‘Eftergi- If you are applying on the grounds of your social velse af gæld til det offentlige’. circumstances and health status, you must document these grounds with e.g. statements from your munici- If there are many appendices to your application, you pality, psychiatric clinic or your own doctor. may need to submit them in several batches. Your case officer will gather all of your appendices and You must document your and your partner’s situation application. You must provide the same documentation for any spouse, registered partner or cohabiting partner. Postal application If both you and your partner are applying for debt You can also send the application form with appen- cancellation, you must both complete an application dices to the Debt Collection Agency, Postbox 49, form. DK-4930 Maribo.

Questions and legal basis

Do you have any questions? Read more about debt cancellation Call us on +45 70 15 73 04 if you are unsure about: You can find the rules concerning debt cancellation in • Whether it is relevant for you to apply for debt the Danish Debt Collection Act (gældsinddrivelseslo- cancellation ven) (Consolidation Act no. 29 of 12 January 2015). • How to complete the form You can find the Act (in Danish) atskat.dk/skattelove . • Which fields you need to complete • How to document any income or expense items. For more information on the rules in our Danish-lan- guage legal guide, section G.A.3.1.6 Eftergivelse af 03

. gæld til det offentlige, see skat.dk/juridiskvejledning. 1 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 3

Application form for cancellation of debt to public authorities

I. Personal Full name Civil registration (CPR) number details

Address

Postcode Town/city

Phone number Email address

Position

II. Your part- Full name of spouse, registered partner or cohabiting partner Civil registration (CPR) number ner’s details

Position

State the date from which you and your partner have had the same address registered in the Danish national register: Your reasons for applying for debt cancellation

III. I am apply- Full debt cancellation ing for Describe why you are applying for full cancellation of your debt (e.g. life-threatening illness):

Partial debt cancellation Describe why you are applying for partial cancellation of your debt. State the amount that you are able to pay: 03 . 1 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 4

Your household’s monthly income and expenses

IV. Monthly How to complete the fields concerning your monthly income income Please disclose all your income during the last three months. You must gather documentation for this income, which you must submit to us together with the completed form. The documentation may be copies of payslips or pension payments.

You must declare your monthly income. If there is income which you receive every three months or every six months, you should divide the amount by either three or six, to get the amount per month. If your income varies from month to month, you should calculate your average income.

Own (amount per Partner (amount per Household in total Income month) month) (amount per month) Income after tax (e.g. , benefits, pension and travel allowance)

Pension scheme payments

Compensation payments (e.g. loss of earnings capacity or loss of breadwinner) Other income (e.g. B-income, maintenance payments or net rental income) Total income (the figures in ‘Household in total’ are added up)

V. Monthly How to complete the fields concerning your monthly expenses expenses You must state your average monthly expenses. You must complete the fields that are relevant for your financial circumstances. If your home is rented, you e.g. do not need to complete ‘Property tax’ under ‘Housing expenses’.

You must gather documentation for all of your expenses, and submit to us together with the comple- ted form. The documentation may be copies of e.g. bills for housing expenses or medicine prescribed by a doctor.

You must declare your monthly expenses. If there are expenses which you pay every three months or every six months, you should divide the amount by either three or six, to get the amount per month.

Household in Transport, trade union and Own (amount per Partner (amount per total (amount per faith-based community expenses month) month) month) Transport costs to and from work How many kilometres do you drive daily? Trade union, unemployment in- surance fund and any early retire- ment scheme contributions Contribution to recognised or ap- proved faith-based community 03 . 1 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 5

Household in Own (amount per Partner (amount per Housing expenses total (amount per month) month) month)

Rent

• Rent subsidy or housing benefit (income)

• Heating subsidy (income)

Mortgage payments (instalment payments) Communal charges to owners’ association

Refuse collection

Property tax

Electricity

Gas

Water

Heating

Building and fire insurance

Other housing expenses

Household in Own (amount per Partner (amount per Other expenses total (amount per month) month) month) Expenses for prescribed medicine and treatment

Maintenance payments

Child support payments

Expenses for child or children’s contact with another parent or yourself

Net expenses for special needs 03 .

1 Any other expenses 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 6

Monthly income and expenses for children under the age of 18 living at home

VI. Children How to complete the fields concerning monthly income and expenses for children in your house- living at home hold You must complete and document your children’s income, expenses and any special needs. You must gather the documentation and submit it to us together with the completed form. The documentation may be copies of e.g. bills for childcare costs or medicine prescribed by a doctor.

You must state the monthly income and expenses If there are income or expense items for the child which you receive or pay every three months or every six months, you should divide the amount by either three or six, to get the amount per month.

Name of child Date of birth Name of child Date of birth

Income Amount per month Income Amount per month Child and youth benefits Child and youth benefits Child allowance Child allowance Child support payments Child support payments Child’s pension Child’s pension Other income for the Other income for the child child Expenses Amount per month Expenses Amount per month

Childcare (e.g. daycare institution) Childcare (e.g. daycare institution) Net expenses for special Net expenses for special needs needs Other expenses for the Other expenses for the child child

Name of child Date of birth Name of child Date of birth

Income Amount per month Income Amount per month Child and youth benefits Child and youth benefits Child allowance Child allowance Child support payments Child support payments Child’s pension Child’s pension Other income for the Other income for the child child Expenses Amount per month Expenses Amount per month

Childcare (e.g. daycare institution) Childcare (e.g. daycare institution) Net expenses for special Net expenses for special needs needs Other expenses for the Other expenses for the child child 03 . 1 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 7

Name of child Date of birth Name of child Date of birth

Income Amount per month Income Amount per month Child and youth benefits Child and youth benefits Child allowance Child allowance Child support payments Child support payments Child’s pension Child’s pension Other income for the Other income for the child child Expenses Amount per month Expenses Amount per month

Childcare (e.g. daycare institution) Childcare (e.g. daycare institution) Net expenses for special Net expenses for special needs needs Other expenses for the Other expenses for the child child Assets and debt of your household

VI. Assets How to complete the fields concerning your assets Your assets are possessions or money that you and your spouse, registered partner or cohabiting part- ner own. You must complete the table with the assets which you and your spouse, registered partner or cohabiting partner each own. If you and your spouse, registered partner or cohabiting partner own something jointly, such as a house or car, you must divide the value between the two columns. You must enter the value for which you think it can be sold. If you have mortgage debt, debt against ow- nership of a housing unit, or against shares or units in a public or private limited liability cooperative housing company, you must include this under ‘debt’.

You must send us an overview of all of your pension savings. This e.g. includes bank, pension pro- vider and insurance company schemes. You must submit details of both employment-based pension schemes and private pension schemes. You can access an overview of your pension savings at pensi- onsinfo.dk.

Asset (what you own individually Own (amount) Partner (amount) or together) Cash funds

Bank deposits Market value of securities (e.g. shares, bonds and units) Cooperative housing unit (value must be documented) Real property (value must be documented)

Car or other motor vehicles Type and value of other assets (e.g. assets abroad) Pension schemes (value must be documented) Your and your partner’s assets (add up each column) 03 . 1 Total assets (add the figures in ‘Your and your partner’s assets’ up) 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 8

VII. Debt How to complete the fields concerning your debt Debt is the amount owed by you and any spouse, registered partner or cohabiting partner. You must complete the tables with all the debt held by you and your spouse, registered partner or cohabiting partner. This means that you must include your debt to e.g. the bank (loan account(s) and overdraft) and instalment contracts. You must also declare the debt against your assets, e.g. house or car.

If both you and your spouse, registered partner or cohabiting partner are liable for the debt, you must divide the debt between the two columns. If you or your partner have more than six creditors, you must include information about the rest of your creditors in an appendix. Your debt (the amount you owe) Outstan- Monthly Established Name of creditor Used for ding debt repayment (month and (amount) (amount) year)

Your debt in total: (add up the amounts in the ‘Outstanding debt’ field)

Your spouse, registered partner or cohabiting partner’s debt (the amount your partner owes) Outstan- Monthly Established Name of creditor Used for ding debt repayment (month and (amount) (amount) year)

Total debt of your partner: (add up the amounts in the ‘Outstanding debt’ field) 03 .

1 Total debt: (add up your and your partner’s debt) 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen) page 9

Other information

VIII. Bankrup- Your , composition and debt rescheduling cases tcy, composi- Are you or a company owned by you subject to or previously subject to proceedings concerning: tion and debt rescheduling Bankruptcy No Yes, when:

Composition No Yes, when:

Debt rescheduling No Yes, when:

Your partner’s bankruptcy, composition and debt rescheduling cases Is your spouse, registered partner or cohabiting partner, or a company owned by your spouse, registe- red partner or cohabiting partner, subject to or previously subject to proceedings concerning:

Bankruptcy No Yes, when:

Composition No Yes, when:

Debt rescheduling No Yes, when:

IX. Inheritan- Your inheritance cases ce Do you have the prospect of an inheri- tance or inheritance advance? No Yes, when:

Have you renounced an inheritance? No Yes, when:

Solemn declaration and signature

X. Declaration I, the undersigned, solemnly declare that: • all information in this application is correct • I have disclosed all of my income • I have disclosed everything that I own and owe.

Date and signature 03 . 1 202 51.005 The Danish Debt Collection Agency (Gældsstyrelsen) is part of the Danish Customs and Tax Admi- nistration (Skatteforvaltningen)