72
THE HONGKONG GOVERNMENT GAZETTE, FEBRUARY 14, 1913.
No. 22-continued.
STATEMENT OF AFFAIRS.
II. As regards Contributories.
(a) Where capital is issued as partly paid up the form hould be altered accordingly.
Capital issued and allotted, viz.:-
Founders' Shares of $
Shareholders.)
per share
(a) Issued as fully paid.
Amount called up at $
as per List "L"
Ordinary Shares of $
per share
Shareholders.)
(a) Issued as fully paid.
Amount called up at $
as per List "M"
Preference Shares of $
(
per share
Shareholders.)
(a) Issued as fully paid.
per share,
per share,
Amount called up at $ per share,
as per List "N”
Amount, if any, paid in advance of call.
$
C.
$
C.
C.
Estimated Surplus as above (if any) subject to
cost of Liquidation
(b) Add particulars (6) of any other capital.
Less unpaid calls estimated to be irrecoverable $
Add deficiency to meet liabilities as above...
Total deficiency as explained in Statement
4
I,
that the foregoing Statement and the several Lists hereunto annexed marked
best of my knowledge and belief, a full, true, and complete statement of the affairs of the above-named Company, on the day of
19 the date of the winding-up order.
1
NOTE. The Commissioner is par- ticularly requested, before swearing the Affidavit, to ascertain that the full name, address, and description of the Deponent are stated, and to initial all crossings-out or other alterations on the printed form. A deficiency in the Affidavit in any of the above respects will entail its refusal by the Court, and will neces- sitate its being re-sworn.
Sworn at
in the Colony of Hongkong
this
day of
Before me,
> Signature.
19
A Commissioner, &c.
make oath and say
are, to the
LIST
"A".
UNSECURED CREDITORS.
The names to be arranged in alphabetical order and numbered consecutively, Creditors for $100 and upwards being placed first.
NOTES.-. When there is a contra account against the creditor, less than the amount of his claim against the Company, the amount of the creditor's claim and the amount of the contra account should be shown in the third column, and the balance only be inserted under the heading "Amount of Debt", thus :-
C.
Total amount of claim Less: Contra account
No such set-off should be included in List "I".
2. The particulars of any bills of exchange and promissory notes held by a creditor should be inserted immediately below the name and address of such creditor.
3. The names of any creditors who are also contributories, or alleged to be contributories, of the Company must be shown separately, and described as such at the end of the List.
No.
Name.
Address and Occupation.
Amount of Debt.
Date when contracted.
Month.
Consideration.
Year.
..
Signature
Dated
19