Proof Of Debt - General Form printable pdf download

Rule 14.4

Proof of debt - general form

In the matter of Example Limited – in Administration

Date of administration – 8 April 2017

You MUST insert the name of the creditor here.

1 Name of creditor

IF the creditor is a company or limited liability partnership, insert the full legal

entity name and the company registered number.

(If a company please also give company registration

IF you are an individual (e.g. a former employee), insert your name.

number)

You MUST insert the address of the creditor here.

2 Address of creditor for correspondence

IF the creditor is a company or limited liability partnership, insert the normal

address for correspondence.

IF you are an individual (e.g. a former employee), insert your address.

3 Email address

Please provide an email address that can be used for any correspondence.

Enter the total amount owed to you as at the appointment date, including the

4 Total amount of claim, including any VAT and

currency.

outstanding uncapitalised interest as at the date

You must include any VAT and uncapitalised interest.

the company went into administration.

Uncapitalised interest is any interest due on your debt up to the date of insolvency

which is not principal debt. You can only claim interest if you are entitled to it

Where payment is made or set-off applied after

under a written contract or legal agreement, or if you demanded it in writing prior

to the date of insolvency and made it clear that interest would be charged from the

the date of administration, this should be

date of the demand.

deducted and relevant deductions disclosed.

You should supply copies of the agreement or demand under which you are

claiming interest.

You must then deduct from this figure any amounts paid to you since the date of

the appointment in relation to the total claim. This does not include payments made

5 Details of any documents by reference to which

for any orders placed by the Joint Administrators.

You must also deduct any amounts in relation to set-off.

the debt can be substantiated. (Note: There is no

Ensure all deductions are clearly disclosed.

need to attach them now but the administrator

may call for any document or evidence to

Please provide details of any documents which support your

substantiate the claim at their discretion as may

claim eg. sales invoices, delivery notes etc. Please also provide

the chairman or convenor of any meeting).

copies of documentation where requested by the administrator.

6 If the amount in 4 above includes outstanding

Confirm the amount of any uncapitalised interest where this has

been included in Box 4 above.

uncapitalised interest, please state the amount.

7 Particulars of how and when the debt incurred.

(If you need more space, append a continuation

Please provide a brief summary of how the debt was incurred.

sheet to this form).

8 Particulars of any security held, the value of the

If you believe you have any security, enter your estimate of the value of the security

you hold i.e. mortgages or charged assets. Also confirm the date of the security.

security, and the date it was given.

9 Particulars of any reservation of title claimed in

If you believe there are retention of title rights in relation to this

claim, enter your estimate of the value of the goods covered by

respect of the goods supplied to which the claim

retention of title.

relates.

10 Signature of creditor or person authorised to act

You MUST sign the form and include your name in BLOCK

on his behalf.

CAPITAL LETTERS.

Name in BLOCK LETTERS

IF you are completing the form as an individual, please state your relationship to

the insolvent entity (i.e. employee or customer). If you are completing the form on

Position with or relation to creditor

behalf of a company or limited partnership please state your role (e.g. Account

Manager, Finance Director or Partner).

Address of person signing (if different from 2

Only complete this section if your contact address in relation to

above)

this matter is not the same as the address provided in Box 2.

Dated

Please date on completion.

Proof Of Debt - General Form

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