Application for payment schedule

Tartu bailiff
Oksana Kuchmei
Ülikooli 2 (5th floor), Tartu 51003
Enforcement case no.   
Debtor’s name   
Telephone number   
E-mail address   
for payment of debt in instalments
I request that the claimant allow me to pay the debt in instalments on the following terms and conditions:
amount of monthly payment date of payment date of first payment

Data of my financial status and income

1. Income
place of work wages (net)
benefit, pension, etc. amount

2. I hold an account (write + in the relevant field)
SEB Bank Swedbank
Luminor Bank Danske Bank
Tallinna Äripank Coop Pank
LHV Bank Citadele Bank
Corporate Bank Svenska Handelsbanken

3. Immovable property

4. Other assets (vehicles, shares in commercial undertakings)

Data of my obligations

1. Dependants

2. Other obligations (home loan, other loans, leasing, debts, other bailiffs)
Please release the following from seizure (write + in the relevant field) if the application for payment schedule is satisfied (write + in the relevant field):
Bank account(s) (give name(s)) 
bank account statement for the period of   .
documents concerning dependents
wage certificate
All of the procedural documents, including the ones that require delivery, must be sent to me:
by unregistered letter to the address:
I am aware that when sent by unregistered letter, a document is deemed to have been received after three days have passed from posting.
to the e-mail address:
I am aware that when sent by e-mail, a document is deemed to have been received from the moment the e-mail message was sent.
I confirm that the submitted data are correct.
applicant’s first name and surname, signature or digital signature date