Proof Of Debt - General Form printable pdf download

Proof Of Debt - General Form

Proof of debt - general form

1 Insolvent company

2 Date of insolvency *

3 Name of creditor

(If a company please also give company registration

number)

4 Address of creditor for correspondence

5 Total amount of claim, including any VAT and

outstanding uncapitalised interest as at the date

the company entered insolvency.

Where payment is made or set-off applied

after the date of insolvency this should

be deducted and relevant deductions disclosed.

6 Details of any documents by reference to

which the debt can be substantiated.

(Note:

There is no need to attach them but the insolvency

practitioner may call for any document or

evidence to substantiate the claim at his discretion

as may the chairman or convenor of any meeting).

7 If the amount in 5 above included outstanding

uncapitalised interest please state the amount.

8 Particulars of how and when the debt incurred (If

you need more space append a continuation

sheet to this form).

9 Particulars of any security held, the value of the

security, and the date it was given.

10 Particulars of any reservation of title claimed in

respect of the goods supplied to which the claim

relates.

11 Signature of creditor or person authorised to act

on his behalf.

Name in BLOCK LETTERS

Position with or relation to creditor

Address of person signing (if different from 2

above)

* Please note that where the company is in liquidation following an administration, the relevant date for claims is the

date the company entered administration and not the date it moved to liquidation, i.e. the date of the first insolvency

event.

Proof Of Debt - General Form