Blank Prozbul Document Form for Completion
We, sitting as a court of three together, were present, and there came before us and said to us: “I hereby deliver to you, Rabbi and Rabbi and Rabbi , the judges here, that any debt owed to me, to my wife, to my sons, and to my daughters, whether by written document or orally, they shall be able to collect whenever they wish.”
And we strengthened their authority so that they may collect all their debts by means of this Prozbul, in accordance with the enactment of Chazal. And in witness thereof we have affixed our signatures on the first day of the week, the twenty-ninth day of the month of Elul, in the year five thousand seven hundred and eighty-two from the creation of the world; all is valid and established.
Signed Judge
Signed Judge
Signed Judge
Instructions:
The handwritten text should, of course, be adjusted for each individual.
If a person is not married, he should delete “and to my wife”; if he has no sons or daughters, he should delete “to my sons”/“to my daughters.” [If there are young children, it is proper to leave them in, since nowadays they may have monetary rights, such as a savings plan for every child.
The names of the judges are the names of the three before whom the Prozbul is being executed.
The person executing the Prozbul should fill in the upper section, including the names of the judges above, but leave the place for the judges’ signatures blank.
He should approach the judges and say to them the following text: “I hereby deliver to you, Rabbi and Rabbi and Rabbi , the judges here, that any debt owed to me, to my wife, to my sons, and to my daughters, whether by written document or orally, they shall be able to collect whenever they wish.”
Afterwards, the judges should sign the document.
Source
Shulchan Aruch (Choshen Mishpat, siman 67).
