Proof of Debt – General Form
Date of Winding-Up Order/Resolution for voluntary winding-up
1 Name of creditor
(If a company please also give company registration
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
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