Who should sign the questionnaire?

An authorized officer or an individual with delegated authority should sign and date the questionnaire. Signatory authority should be documented internally to ensure the response is binding and to support later verification.

Can the questionnaire be e-signed?

Yes. Electronic signatures are legally valid under federal ESIGN and state UETA frameworks for most insolvency-related documents, provided intent, consent, attribution, and retention requirements are met.

Are notarization or witnesses required?

Not typically for standard questionnaires, but certain attachments or certifications may require notarization or witnesses depending on state law or lender requirements. Confirm with counsel for jurisdictional exceptions.

How should privileged information be handled?

Mark privileged entries and route them for counsel review before external distribution. Redact privileged legal analysis from shared copies while providing factual support where needed.

What if information changes after submission?

Prepare an updated questionnaire with a revision date and summary of changes. Maintain prior versions and document reasons for amendments to preserve auditability.

How long should records be retained?

Retain completed questionnaires and attachments at least as long as the relevant legal or tax retention period—commonly three to seven years, longer for healthcare or real estate—consistent with internal records policies.

Electronic Signature
Templates
Miscellaneous
Business Insolvency Questionnaire

Business Insolvency Questionnaire

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Business Insolvency Questionnaire and Engagement Agreement

Parties and Recitals

This Agreement is entered into on Date: by and between Client Name: (the "Client") and Service Provider Name: (the "Service Provider").

WHEREAS, the Client has experienced or reasonably anticipates financial distress, liquidity constraints, or an event which may give rise to insolvency proceedings that require evaluation and potential restructuring; and

WHEREAS, the Service Provider has agreed to collect factual, financial and operational information from the Client and to provide advisory and related services as described in the Scope of Work below for the purposes of assessing the Client's financial condition and recommending commercial or restructuring options; and

WHEREAS, the parties desire to set forth the terms of the engagement, including payment, confidentiality and governing law, and to gather the information necessary to enable the Service Provider to perform its services.

Insolvency Events and Status

Has the company closed operations or ceased significant business activities? Yes No

Has any insolvency or restructuring filing been made by or against the company? Yes No If yes, Filing Date:

Brief description of events leading to insolvency

Financial Summary

Total Assets (current book value) Total Liabilities (current)

Cash on Hand

Monthly Cash Burn

Revenue (last 12 months)

Accounts Receivable (total) Accounts Payable (total)

Creditors and Liabilities

List of Secured Creditors (name, collateral, priority) List of Unsecured Creditors (name, claim amount) Material Loans, Guarantees or Liens (describe)

Assets and Contracts

Key Assets (real property, inventory, IP) Material Contracts (customers, suppliers, leases) — list and state any termination or assignment restrictions Pending Litigation or Regulatory Actions

Operations and Employees

Number of employees (FTE): Payroll current? Yes No

Critical operational considerations or supply chain disruptions

Recovery, Restructuring and Additional Information

Steps already taken to address insolvency (e.g., cost reductions, forbearance, asset sales) Additional documents to be provided (list)

Scope of Work

Defined Scope

Payment Terms

Engagement Fee / Retainer Amount Payment Schedule (milestones or dates)

Late fee for overdue invoices: % per month on the outstanding balance, compounded monthly, plus costs of collection, including reasonable attorneys' fees.

Term and Termination

Term Commencement Date: Term Expiration Date:

Either party may terminate this engagement for material breach or insolvency upon written notice delivered to the other party. Required notice prior to termination (if for convenience): days.

Confidentiality

The parties agree that all non-public information exchanged in connection with this engagement, including financial statements, creditor lists, contracts and business plans, shall be treated as Confidential Information. The Service Provider shall use Confidential Information solely for the performance of the Scope of Work. Confidential Information shall not include information that (i) is or becomes generally available to the public other than through a breach of this Agreement, (ii) is rightfully received from a third party without restriction, or (iii) is independently developed without the use of the Confidential Information.

The Service Provider may disclose Confidential Information to its employees, subcontractors and professional advisors who have a need to know for purposes of performing the engagement and who are bound by confidentiality obligations at least as protective as those contained herein. The Client acknowledges that the Service Provider may be required to disclose information pursuant to applicable law, court order, or regulatory requirement, in which case the Service Provider will provide prompt notice to the Client to the extent permitted.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles.

Entire Agreement

This Agreement, together with any schedules and exhibits executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. Any amendment to this Agreement must be in writing and signed by both parties.

Client Certification

By executing below, the undersigned certifies that the information provided in this Questionnaire is true, accurate and complete to the best of the undersigned's knowledge and that the undersigned is authorized to provide such information on behalf of the Client. The undersigned understands that the Service Provider will rely on this information in performing the engagement.

I certify under penalty of perjury under the laws of the applicable jurisdiction that the foregoing is true and correct.

Acknowledgement

I acknowledge and certify the foregoing statements and understand that materially false statements may subject me to penalties under applicable law.

Client:

By:

Date:

Service Provider:

By:

Date:

What the Business Insolvency Questionnaire Is

A Business Insolvency Questionnaire is a structured form used to collect financial, operational, and legal information about a company facing insolvency, restructuring, or creditor inquiries. It centralizes details such as entity structure, outstanding liabilities, secured and unsecured creditor lists, cash flow projections, recent transfers, contracts, pending litigation, and key stakeholders. The questionnaire supports creditors, turnaround professionals, counsel, and regulators by standardizing responses, enabling faster analysis of solvency issues, prioritizing claims, and documenting disclosures required for formal proceedings, workouts, or negotiated settlements.

Why a Standard Questionnaire Matters

Using a consistent Business Insolvency Questionnaire reduces information gaps, shortens review cycles, and creates an auditable record for negotiations, creditor committees, or court filings. It helps ensure comparable data across reporting periods and between counterparties.

Who Completes and Reviews the Questionnaire

Multiple parties rely on the questionnaire to assess insolvency risk, coordinate responses, and preserve evidence during restructuring.

Company officers and finance teams complete factual financial and operational responses for accuracy and internal review.
Outside counsel and turnaround advisors review legal, contract, and litigation disclosures for completeness.
Creditors, banks, and committee members use responses to evaluate claims, priorities, and potential recovery scenarios.

Clear authorship, dated entries, and attachments make responses defensible in negotiations and formal proceedings.

Step-by-step: Completing the Questionnaire

Complete the questionnaire in logical stages to keep responses consistent and to allow internal review before external distribution.

01

Stage 1 — Gather records: Collect formation docs, recent financials, bank statements, credit agreements.
02

Stage 2 — Populate fields: Enter requested data, attaching schedules and exhibits where noted.
03

Stage 3 — Internal review: Have finance and legal review for accuracy and privilege concerns.
04

Stage 4 — Finalize and certify: Sign, date, and add author contact details before distribution.

Typical Workflow for Distribution and Review

A standard process helps preserve auditability: collect, review, authorize, distribute, and archive responses.

Collect: Assemble financial statements, ledgers, and contract exhibits.
Review: Legal and finance verify completeness and privilege status.
Authorize: Authorized officer signs and dates the completed questionnaire.
Distribute: Send to lenders, counsel, or committee with tracked delivery and receipt.

Configuring a Digital Review Workflow

If using an electronic system, configure fields, authentication, and routing before sending to ensure consistent processing.

Field	Configuration
Required Fields	Mark legal name, EIN, and signature as required
Conditional Sections	Show creditor schedule only if liabilities exceed threshold
Signer Authentication	Use email + SMS code for primary signers
Audit Trail	Enable IP, timestamp, and version history logging

Technical Considerations for eSubmission

Choose a platform that supports secure uploads, configurable fields, and a verifiable audit trail.

Document formats: PDF and DOCX are standard for preserving layout
Integrations: Connectors to ERP, CRM, and cloud storage simplify evidence collection
Authentication: Support for SMS, email, and optional knowledge-based verification

Ensure the chosen platform meets your compliance needs and captures signer attribution and timestamps for each response.

Essential Sections to Include in the Questionnaire

A professional questionnaire organizes material facts into discrete, verifiable sections to reduce ambiguity and speed analysis.

Entity Details

Legal name, formation date, state of formation, EIN, DBA names, and principal place of business.

Financial Statements

Balance sheet, income statement, cash flow statement and most recent interim management accounts.

Creditor Schedules

List secured and unsecured creditors, outstanding balances, maturity dates, and collateral descriptions.

Contracts and Leases

Material contracts, lease obligations, termination provisions, and change-of-control clauses.

Litigation and Claims

Pending suits, arbitration matters, regulatory investigations, and estimated exposures.

Intercompany and Related Parties

Transactions with affiliates, outstanding receivables/payables, and guarantees or loans.

Core Data Points Required

Legal Name: Entity's official name

EIN: Federal Tax ID

Primary Contact: Authorized officer contact

Bank Accounts: Account numbers and institutions

Debt Summary: Totals by secured/unsecured

Material Contracts: Key counterparty names

Risks and Consequences of Inaccurate Responses

Regulatory Exposure: Incorrect disclosures can prompt investigations

Creditor Claims: Omits may alter priority or recovery

Bankruptcy Risks: Misstatements can affect plan confirmation

Tax Liability: Errors may trigger audits or penalties

Contract Defaults: Failure to disclose may breach agreements

Reputational Harm: Stakeholder trust can be eroded

Common Preparation Pitfalls

Incomplete creditor contact details delay analysis and outreach
Mixing unaudited and audited figures causes reconciliation problems
Failing to attach supporting exhibits forces repeated follow-ups
Using inconsistent dates across schedules complicates cashflow assessment

eSignature Pricing and Capability Snapshot

A concise vendor comparison shows starting price and key capability markers to consider when e-signing insolvency questionnaires.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial, no credit card required	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Timing and Deadlines to Track

Certain response items and filings have deadlines tied to tax, regulatory, or court schedules; track due dates carefully.

Immediate Responses:

Bank inquiries and payor holds often require same-day or 48-hour replies

Tax Filings:

Keep in mind general three-year IRS record requirements when assembling prior returns

Court Filings:

Court-ordered disclosures follow specific scheduling in the proceeding

Notarization Windows:

Some documents require in-person or RON completion within specific timeframes

Retention Cutoffs:

Preserve documents per retention policy while litigation or audits are possible

Practical Tips for Accurate and Efficient Completion

Use consistent sources, date-stamped exhibits, and clear signatory authority to minimize rework and legal risk.

Source Reconciliations

Reconcile balances to bank statements and general ledger before submitting

Version Control

Use clear filenames and an audit trail to avoid multiple competing versions

Privilege Review

Have counsel review sensitive disclosures for attorney-client privilege before external release

Clear Attachments

Attach labeled exhibits and reference them inline for reviewer ease

Practical Examples of Use

Real-world scenarios illustrate how questionnaires support different insolvency workflows and stakeholders.

Lender Workout Scenario

A distressed borrower provided a completed questionnaire to a lender committee

Lender used the creditor schedule to verify secured claims
The standardized format expedited a forbearance agreement and reduced negotiation cycles by clarifying collateral priorities and exposures in one reviewable package.

Pre-bankruptcy Assessment

Management completed a detailed questionnaire for outside counsel

Counsel identified unrecorded liens during review
Early detection allowed corrective UCC filings and improved the estate's negotiating position before a formal insolvency filing.

Frequently Asked Questions

Answers to common questions about preparing, signing, and storing Business Insolvency Questionnaires.

Need help? Contact support

Who should sign the questionnaire?
An authorized officer or an individual with delegated authority should sign and date the questionnaire. Signatory authority should be documented internally to ensure the response is binding and to support later verification.
Can the questionnaire be e-signed?
Yes. Electronic signatures are legally valid under federal ESIGN and state UETA frameworks for most insolvency-related documents, provided intent, consent, attribution, and retention requirements are met.
Are notarization or witnesses required?
Not typically for standard questionnaires, but certain attachments or certifications may require notarization or witnesses depending on state law or lender requirements. Confirm with counsel for jurisdictional exceptions.
How should privileged information be handled?
Mark privileged entries and route them for counsel review before external distribution. Redact privileged legal analysis from shared copies while providing factual support where needed.
What if information changes after submission?
Prepare an updated questionnaire with a revision date and summary of changes. Maintain prior versions and document reasons for amendments to preserve auditability.
How long should records be retained?
Retain completed questionnaires and attachments at least as long as the relevant legal or tax retention period—commonly three to seven years, longer for healthcare or real estate—consistent with internal records policies.

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