Proof Of Debt - General Form printable pdf download

Proof Of Debt - General Form

Rule 4.73

Form 4.25

Proof of Debt – General Form

(TITLE)

Date of Winding-Up Order/Resolution for voluntary winding-up

1 Name of creditor

(If a company please also give company registration

number).

2 Address of creditor for correspondence.

3 Total amount of claim, including any Value Added

Tax and outstanding uncapitalised interest as at the

date the company went into liquidation.

4 Details of any documents by reference to which the

debt can be substantiated. (Note: There is no need to

attach them now but the liquidator may call for any

document or evidence to substantiate the claim at his

discretion as may the chairman or convenor of any

meeting).

5 If amount in 3 above includes outstanding

uncapitalised interest please state amount.

6 Particulars of how and when debt incurred

(If you need more space append a continuation sheet

to this form).

7 Particulars of any security held, the value of the

security, and the date it was given.

8 Particulars of any reservation of title claimed in

respect of goods supplied to which the claim relates.

9 Signature of creditor or person authorised to act on his behalf

__________________________________________________

Name in BLOCK LETTERS

__________________________________________________

Position with or in relation to creditor

__________________________________________________

Address of person signing (if different from 2 above)

Admitted to vote for

Admitted for dividend for

Proof Of Debt - General Form