DIY Legal Forms

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Bankruptcy Reaffirmation Agreement

This agreement made, effective as of [Date], by and between [Name], of [Address], in the County of [County], referred to as the creditor, and [Name], of [Address], in the County of [County], referred to as the debtor.

The parties agree as follows:


On [Date], a petition for relief under Chapter [--] of Title 11 of the United States Code was filed [Name] (By or Against) the debtor in the Bankruptcy Court for the District of [District]. On the date of the filing of such petition, debtor was, and still is, indebted to creditor for $------ [description of the basis of the debt, i.e.; on a written promissory note dated].


The debtor fully understands the fact that debtor would be entitled to discharge of this indebtedness when and if a discharge is granted in the pending proceedings, but wishes to repay the debt in partial consideration for an additional loan that a creditor desires to make to the debtor.

Therefore, in consideration for an additional loan to be made to a debtor, by a creditor, and subject to any court approval which may be required by 11 USC Sec 524(c) or (d), the debtor agrees to reaffirm the indebtedness, agrees that the indebtedness will survive discharge, and agrees to repay the debt to the creditor, the reaffirmed indebtedness and the additional indebtedness to be repaid in accordance with the following terms and conditions:

In witness whereof, the parties have executed this agreement at [Place of Execution] the day and year first above written.

Signature of Debtor

Signature of Creditor

*** If Required By State Law ***

This Section for Notary:


State of _________

County of ________ [County]

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

Signature ________

My commission expires: _____