Official Form B 3A Application for Individuals to Pay the Filing Fee in Installments

The debtor applying for permission for paying the required filing fee to the agreed amount in installments. The mentioned form is in compliance with Fed. R. Bankr. P. 1006.

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Official Form B 3A Application for Individuals to Pay the Filing Fee in Installments   
Official Form B 3A 
Application for Individuals to Pay the Filing Fee in Installments	        	12/14	 	
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying  correct 
information. 
Part 1:   Specify Your Proposed  Payment Timetable 
1. 	Which chapter of the Bankruptcy Code 
are you choosing to file under? 	 	Chapter 7 	
 	Chapter 11 	
 	Chapter 12  	
 	Chapter 13	 	
2. 	You may apply to pay the filing fee in up to 
four installments. Fill in the amounts you 
propose to pay and the dates you plan to 
pay them.  Be sure all dates are business 
days. Then add the payments you propose 
to pay.  
You must propose to pay the entire fee no 
later than 120 days after you file this 
bankruptcy case. If the court approves your 
application, the court will set your final 
payment timetable.   You propose to pay… 	  	
$_____________ 	 	With the filing of the 
petition	 	
 	On or before this date  .......	.______________   MM   /   DD  / YYYY	  	
$_____________ 	On or before this date ...........  	______________     MM   /   DD  / YYYY	 	
$_____________ 	On or before this date ...........  	______________     MM   /   DD  / YYYY	 	
 	+ $_____________ 	On or before this date ...........   	______________     MM   /   DD  / YYYY	 	
Total 	$______________ 	◄ 	Your total must equal the entire fee for the chapter you checked in line 1.	 	
 	
Part 2:  Sign Below 
By signing here, you state that you are unable to pay the full filing fee at once, that you want to pay the fee in installments, and that you understand that: 
 	You must pay your entire filing fee before you make any more payments or transfer any more property to an attorney, bankruptcy  petition 
preparer, or anyone else for services in connection with your bankruptcy case. 	
 	You must pay the entire fee no later than 120 days after you first file for bankruptcy, unless the court later extends your dea dline. Your 
debts will not be discharged until your entire fee is paid. 	
 	If you do not make any payment when it is due, your bankruptcy case may be dismissed, and your rights in other bankruptcy proce edings 
may be affected.  	
_________________________________ 	___________________________________ 	_______________________________________ 	      	Signature of	 Debtor 1  Signature of Debtor 2  Your attorney’s name and signature, if you used one 	
Date   _________________    Date   ________________    Date   _________________   MM  /  DD  / YYYY   MM  /  DD  / YYYY MM  /  DD  / YYYY 	
Debtor 1    ________________________________________________________________   	First Name Middle Name Last Name	 	
Debtor 2  ________________________________________________________________ (Spouse, if filing)	 First Name  Middle Name Last Name	 	
United States Bankruptcy Court for the:	 _____________________	 District of ___________	 	  	 	
Case number  ___________________________________________    (If known) 
 
  Fill in this information to identify your case: 	
 	Check if this is an 
amended filing

Order Approving Payment of Filing Fee in Installments 
After considering the Application for Individuals to Pay the Filing Fee in Installments  (Official Form B 3A), the 
court orders that: 
[ ] The debtor(s) may pay the filing fee in installm ents on the terms proposed in the application. 
[ ] The debtor(s) must pay the filing fee according to the following terms: 	
   You must pay… 	On or before this date… 	
$_____________ 	_____________ Month / day / year  	
$_____________ 	_____________ Month / day / year	
$_____________ 	_____________ Month / day / year	
+ $_____________	_____________  Month / day / year	
Total 	$_____________ 	
Until the filing	

 fee is paid in full, the debtor(s) must  not make any additional payment or transfer any 
additional property to an attorney or to anyone el se for services in connection with this case. 	
_____________ 	By the court:	 _____________________________________   	
Month / day / year	 United States Bankruptcy Judge 	
Debtor 1    ________________________________________________________________   	First Name  Middle Name Last Name	 	
Debtor 2  ________________________________________________________________ (Spouse, if filing)	 First Name  Middle Name Last Name	 	
United States Bankruptcy Court for the:	 _____________________	 District of ___________	 	  
Case number  ___________________________________________  (If known) Chapter filing under: 		Chapter 7 		Chapter 11 		Chapter 12 		Cha	pter 13	
  Fill in this information to identify the case: