Form 4.25 - Proof Of Debt - General Form
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1PROOF OF DEBT - GENERAL FORM
Form 4.25
Voluntary Arrangement
and in the matter of The Insolvency Act 1986
1.
Name of Creditor & relevant reference/
account number
2.
Address of Creditor
3.
Total amount of claim, including any Value
Added Tax and outstanding uncapitalised
£
interest as at the date of approval of the
voluntary arrangement
3a
Amount of Bank charges included
£
3b
Amount of PPI in claim
£
3c
Amount of Interest in Claim
£
4.
Details of any document by reference to
which the debt can be substantiated. [Note
the supervisor may call for any document or
evidence to substantiate the claim at his
discretion]
5.
If total amount above includes outstanding
£
uncapitalised interest please state amount
6.
Give details of whether the whole or any part
Category
of the debt falls within any (and if so which)
of the categories of preferential debts under
section 386 of, and schedule 6 to, the
Insolvency Act 1986 (as read with schedule 3
to the Social Security Pensions Act 1975)
Amount(s) claimed as preferential £
7.
Particulars of how and when debt incurred.
8.
Particulars of any security held, the value of
the security, and the date it was given
£
9.
Signature of creditor or person authorised to
act on his behalf
Name in BLOCK LETTERS
Position with or relation to creditor
B A C S D E T A I L S F O R D I V I D N E D
A/c No:
PAYMENTS
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