Case caption
The names of Debtor 1 and Debtor 2 (spouse, if filing), the bankruptcy court district, the case number if known, and a box for an amended filing.
B 104
For Individual Chapter 11 Cases: The List of Creditors Who Have the 20 Largest Unsecured Claims Against You Who Are Not Insiders
- Agency
- U.S. Courts
- Revision
- 12/15
- Fillable fields
- 370
- Pages
- 5
- Official source
- U.S. Courts form page
- Checked
- October 20, 2026
Form B 104: List of Creditors Who Have the 20 Largest Unsecured Claims Against You
Form B 104, printed as Official Form 104, is For Individual Chapter 11 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims Against You and Are Not Insiders. It is an Official Bankruptcy Form from the U.S. Courts, listed under Individual Debtors and effective on December 1, 2015. The U.S. Courts page says it is derived from Official Form 4, and that Official Bankruptcy Forms are approved by the Judicial Conference and must be used under Bankruptcy Rule 9009.
The form says an individual filing for bankruptcy under Chapter 11 fills it out, and that people filing under Chapter 7, Chapter 12 or Chapter 13 do not. It has a numbered section for each of 20 unsecured claims, listed from largest to smallest, and leaves out insiders and secured creditors, unless the unsecured part of a secured claim is among the 20 largest. The committee note says the form was renumbered to set it apart from the version used in chapter 11 cases filed by non-individuals, such as corporations and partnerships.
This page explains the form in plain words and is not legal advice. You can fill it out free in your browser on this page and download the result without an account.
What's on Form B 104
Who counts as an insider
The form lists relatives, general partners and their relatives, partnerships where you are a general partner, corporations where you are an officer, director, person in control or owner of 20 percent or more of the voting securities, and any managing agent (11 U.S.C. § 101).
Part 1: The 20 unsecured claims
Twenty numbered sections, from largest to smallest. Each asks for the creditor's name, address, contact and contact phone, the nature of the claim, and the unsecured claim amount.
Contingent, unliquidated or disputed
For each claim, boxes show whether, as of the date you file, it is contingent, unliquidated, disputed, or none of these. The instructions say a claim can have one, more than one, or none of them.
Liens on your property
If the creditor has a lien on your property, the section asks for the total claim (secured and unsecured), subtracts the value of security, and shows the unsecured claim.
Part 2: Sign Below
Each debtor declares under penalty of perjury that the information provided in the form is true and correct, then signs and dates it.
How to fill out Form B 104
- 1
Fill in the caption
Enter the name of Debtor 1 and, in a joint case, Debtor 2, the district, the case number if known, and check the box if this is an amended filing.
- 2
Leave out insiders
The form says not to include claims by anyone who is an insider, and gives examples such as relatives and corporations in which you own 20 percent or more of the voting securities.
- 3
Work out partly secured claims
For a creditor with a lien, subtract the value of security from the total claim. The instructions give an example: owing $30,000 on a car worth $20,000 leaves a $10,000 unsecured claim.
- 4
List claims largest first
Fill one numbered section per claim, from largest to smallest. The instructions say claims that are uncertain when you file, or become due only after you file, are included too.
- 5
Describe each claim
Fill in the nature of the claim, such as the instructions' examples of trade debts, bank loans, professional services and government contracts, and check contingent, unliquidated, disputed or none of the above.
- 6
Sign and date
Each debtor signs and dates Part 2 under penalty of perjury.
Why fill Form B 104 on indox
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Where it is filed, privacy and warnings
Where it is filed
With the United States Bankruptcy Court for the district named in the caption. The instructions say it is filed when the chapter 11 case is filed with the court.
Filing fee
The form does not print a fee for this list.
Matching the schedules
The instructions say every creditor listed on this form is also listed on Schedule D (Official Form 106D) or Schedule E/F (Official Form 106E/F).
Children as creditors
The instructions booklet says not to list a minor child's full name, only the child's initials and the full name and address of the child's parent or guardian (11 U.S.C. § 112; Bankruptcy Rule 1007(m) and 9037). The committee note says this direction moved from the form to the booklet.
False statements
The instructions booklet says making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both.
Related forms
B 101
Voluntary Petition for Individuals Filing for Bankruptcy
159 fields, 9 pages
B 106D
Schedule D: Creditors Who Hold Claims Secured By Property (individuals)
186 fields, 3 pages
B 106E/F
Schedule E/F: Creditors Who Have Unsecured Claims (individuals)
323 fields, 6 pages
B 106 Summary
A Summary of Your Assets and Liabilities and Certain Statistical Information (individuals)
28 fields, 2 pages
B 106 Declaration
Declaration About an Individual Debtor’s Schedules
15 fields, 1 page
Who uses Form B 104?
The debtor fills out and signs the form. It is for individual Chapter 11 cases only.
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Questions about Form B 104
Who fills out Form B 104?
The form says an individual filing for bankruptcy under Chapter 11 fills it out, and that people filing under Chapter 7, Chapter 12 or Chapter 13 do not.
Who is an insider on Form B 104?
The form lists relatives, general partners, relatives of general partners, partnerships of which you are a general partner, corporations of which you are an officer, director, person in control, or owner of 20 percent or more of their voting securities, and any managing agent, including one for a business you operate as a sole proprietor.
Are secured creditors listed?
Only in one case. The form says not to include claims by secured creditors unless the unsecured claim resulting from inadequate collateral value places the creditor among the holders of the 20 largest unsecured claims.
What do contingent, unliquidated and disputed mean?
The instructions say a claim is contingent if it is owed only if a particular event occurs after filing, such as a cosigned loan, unliquidated if the amount cannot be readily determined, such as unset car accident damages, and disputed if you do not agree that you owe the debt.
How is a minor child listed as a creditor?
The instructions booklet says to fill in only the child's initials and the full name and address of the child's parent or guardian, for example A.B., a minor child (John Doe, parent, 123 Main St., City, State).
Is this page legal advice?
No. This page explains the form in plain words and is not legal advice. The instructions booklet notes that it is extremely difficult to succeed in a chapter 11, 12, or 13 case without an attorney.