Your First name/Last name

Address

Postal code/ CITY

Banque de France

Overindebtedness Commission

Address

Postal code/ City

Done in [your city], on [specify the date].

Subject: Submission of a file to the Overindebtedness Commission

Madam, Sir,

By this letter, I request to be admitted to the procedure for handling situations of overindebtedness. Indeed, following [indicate the event that led to your situation], I am no longer able to pay all my expenses.

These amount to [indicate the amount of your expenses], while my income amounts to [indicate the amount of your income].

Please find enclosed the completed form along with the required supporting documents.

While awaiting your reply, please accept, Madam, Sir, the expression of my best regards.

[Your signature]