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Applicant: [insert initials and surname]: 1st: (exhibits).1–4: [insert date] 20[insert year]

Court Reference No: [INSERT COURT REF. NUMBER]

[IN THE HIGH COURT OF JUSTICE

BUSINESS AND PROPERTY COURTS [OF ENGLAND AND WALES OR IN [INSERT LOCATION]]

INSOLVENCY AND COMPANIES LIST (ChD)

OR

IN THE COUNTY COURT AT [INSERT LOCATION]

[BUSINESS AND PROPERTY COURTS LIST]

OR

IN THE HIGH COURT OF JUSTICE

CHANCERY DIVISION

[INSERT LOCATION] DISTRICT REGISTRY]

IN BANKRUPTCY

IN THE MATTER OF [INSERT DEBTOR’S OR BANKRUPT’S NAME]

AND IN THE MATTER OF THE INSOLVENCY ACT 1986

1. [Insert name of the full name of the petitioning creditor]        Applicant

1. And

1. [Insert name of the debtor]        [Respondent OR Respondents]

Witness statement of [insert name of the person making the statement], the solicitor for the petitioning creditor in support of an application for an order for substituted service of a bankruptcy petition

I, [insert name of the person making the statement], of [insert the witnesses’ details or business address, firm and title]