Reaffirmation Agreement Template (11 U.S.C. § 524)

United States Bankruptcy Court
District of [District]

In re: [Debtor Name(s)]
Case No.: [Number]
Chapter: [7]

This Reaffirmation Agreement is between [Creditor Name] ("Creditor") and [Debtor Name(s)] ("Debtor").

1. Disclosures

• Amount of debt to be reaffirmed: $[Amount].
• Interest rate: [Rate]%. Payment schedule: [Monthly/Quarterly], $[Payment Amount] due on [Due Date].
• Collateral securing debt: [Description, VIN/serial, property address].
• Statement that this agreement is voluntary and not required by law.

2. Terms of Agreement

• Debtor agrees to remain personally liable for the above debt according to original or modified terms.
• Any default will permit Creditor to enforce rights under applicable law.
• No additional fees or charges beyond disclosed amounts.

3. Financial Statements

• Debtor’s monthly income: $[Amount] (attach Schedule I if unchanged).
• Debtor’s monthly expenses: $[Amount] (attach Schedule J if unchanged).
• Explanation of ability to make payments and any budget adjustments.

4. Attorney Declaration (if represented)

• Attorney [Name] certifies that Debtor was fully informed, agreement does not impose undue hardship, and Debtor voluntarily entered into agreement. Attorney signature and bar number.

5. Debtor Certification

• Debtor acknowledges understanding of legal effect, right to rescind within 60 days or prior to discharge entry, whichever occurs later.
• Debtor affirms ability to make payments and that the agreement is in best interest.

6. Court Approval (if required)

• If Debtor not represented by attorney, schedule hearing for court approval. Include section for judge’s findings and signature.

7. Signatures

Creditor: [Creditor Name]
By: __________________________
Name: [Authorized Representative]
Title: [Title]
Date: __________

Debtor: [Debtor Name]
Signature: _____________________
Date: __________

Joint Debtor (if any):
Signature: _____________________
Date: __________

Attorney for Debtor:
Signature: _____________________
Name/Bar No.: [Name/Number]
Date: __________

Court Approval (if necessary):

IT IS ORDERED that the Reaffirmation Agreement is ☐ approved ☐ disapproved.

Date: __________
__________________________________
[Judge Name], United States Bankruptcy Judge

Ensure compliance with Official Form 2400A/B ALT or appropriate reaffirmation form required by the court.

Local Rules Checklist

• Confirm local bankruptcy rules, judge procedures, and any required local forms.
• Verify notice and service requirements, including creditor matrix format.
• Check deadlines in the scheduling order and use the correct CM/ECF event.