Proof Of Debt - Australian Government Page 4
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2
3
4Details of Debt/s
Date debt/s incurred Details of debt/description (see note 2)
GST
Amount ($)
(see note 7)
Less: Payments received in reduction of debts
Less: Estimated value of security
Amount claimed
Creditor Declaration
I declare that the bankrupt/debtor/s owe/s the amount claimed by the creditor named above.
Title
Given name/s
Surname
Signature
Date (DD/MM/YYYY)
Note: Lodging a false proof of debt is an offence which is punishable by imprisonment for 5 years: s263(1)(d).
Admin Use Only
Trustee Use Only
Amount admitted in estate
Creditor ID
1
2
3
Preferential ($)
Liability ID
Amount rejected ($)
Ordinary ($)
POD No.
Reason rejected
Deferred ($)
SoA Amt.
Total Admitted ($)
Reg’d. in estate
Date of Reg’n.
Signature of trustee
Date (DD/MM/YYYY)
- 1300 364 785
page 4 of 4
8(POD)(P)022015
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