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聲明參與分配狀(有擔保物權或優先受償權)(Application For Participation In the Distribution)

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  • 最後更新日期:108-9-18
  • 資料點閱次數:593

聲明參與分配狀

Application For Participation In The Distribution

案號及股別:

Case No. and Section:

聲  明  人                   住址:

                        身分證字號:

                        電話:                 傳真:

 

Applicant              Address:

                       I.D. Card No.:

                       Telephone:               Fax:

                    

法定代理人              住址:

                        身分證字號:

                        電話:                 傳真:

送達代收人              住址:

                        電話:

 

Legal Representative      Address:

                      I.D. Card No.:

                      Telephone:               Fax:

Agent for Service     Address:

                      Telephone:

 

義 務 人               住址:

    身分證字號:

    電話:                  傳真:

送達代收人              住址:

                        電話:

Obligor               Address:

                      I.D. Card No.:

Agent for Service     Address:

                      Telephone:

 

 

 

為聲明參與分配事:

To request the following matters relating to participation in distribution:

    聲明

請准聲明人以新臺幣        元,並自民國            日起至            日止,按週年利率百分之    計算之利息及違約金,就貴分署      年度      字第         號義務人               行政執行事件參與分配。

Please permit the applicant in this matter (Case No.[*]; Obligor [name]) to participate in the distribution of funds and be entitled to receive interest of NT$[*], calculated at an annual rate of [*]%, commencing on [date] and ending on [date], and penalties, if any.

 

    事實及理由

貴分署    年度          字第       號行政執行事件,業將義務人            所有如附件所示不動產查封在案。聲明人對上述不動產有第    順位抵押權擔保債權新台幣             元存在,迄今全未受償。為此檢具抵押權設定契約書、他項權利證明書及借據,請求參與分配。

Facts:

In case no. [*], the branch has sealed all of the obligor’s real estate as listed in the attachment.  The applicant has a [#] mortgage in the aforementioned real estate in the amount of NT[*] that has yet to be fully satisfied.  Please see attached the Mortgage Setting Contract, Other Right Certificate and Certificate of Indebtedness.  Please grant the applicant the right to participate in the distribution.

 

附件:

一、抵押權設定契約書  件

二、他項權利證明書  件

三、借據  件

Attachments:

  1. Mortgage Setting Contract
  2. Other Right Certificate
  3. Certificate of Indebtedness

此致

法務部行政執行署臺南分署    公鑒

Respectfully submitted to Tainan Branch, Administrative Enforcement Agency, Ministry of Justice.

                                                

Date

              具狀人              (簽名蓋章)[Signature/Seal of Applicant]

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