Form 4.25 - Proof Of Debt - General Form
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1Rule 4.73
Form 4.25
PROOF OF DEBT - GENERAL FORM
B0023
In the matter of Base Logic Productions Limited t/a Bloc
and in the matter of The Insolvency Act 1986
1.
Name of Creditor
2.
Address of Creditor
3.
Account Number/Reference of Creditor
A/C No:
Ref:
4.
Total amount of claim, including any Value Added
Tax and outstanding uncapitalised interest as at the
£
date of liquidation.
5.
Details of any document by reference to which the
debt can be substantiated. [Note the liquidator may
call for any document or evidence to substantiate the
claim at his discretion]
6.
If the total amount shown above includes Value
Added Tax, please show:-
(a) amount of Value Added Tax
£
(b) amount of claim NET of Value Added Tax
£
7.
If total amount above includes outstanding
£
uncapitalised interest please state amount
8.
If you have filled in both box 4 and box 6, please
state whether you are claiming the amount shown in
box 4 or the amount shown in box 6(b)
9.
Give details of whether the whole or any part of the
Category
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 £
10.
Particulars of how and when debt incurred.
11.
Particulars of any security held, the value of the
security, and the date it was given
£
12.
Signature of creditor or person authorised to act on
his behalf
13.
Name in BLOCK LETTERS
14.
Position with or relation to creditor
15.
Dated
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