CAP. 6]
Bankruptcy.
FORM 28.
[s. 18(1); rules 81, 150.]
* Sheet "L" should be substituted for any one or more of such of the sheets named as will have to be returned To the Debtor,
STATEMENT OF AFFAIRS.
(Title.)
You are required to fill up, carefully and accurately, this sheet and such of the several sheets A, B, C, D, E, F, G, H, I, J, K, L and M* as are applicable showing the state of your affairs on the day on which the receiving order was made against you, 19 day of
Such sheets, viz. the will constitute your Statement of Affairs, and must when filled up, be verified by oath, declaration or affirmation.
Gross liabilities.
Liabilities (as stated and estimated by debtor).
Expected to rank:
Assets (as stated and estimated by debtor).
Unsecured creditors as per list (A)
Creditors fully secured as per list (B)
Estimated value of securities
Surplus
Less amount thereof carried to sheet (C)
Balance thereof to contra
Creditors secured partly per as
Property as per list (H), viz.
(a) Cash at bankers
(b) Cash in hand
(c) Cash deposited with solicitor for costs of petition
(d) Stock-in-trade (cost $ >
(e) Machinery
(f) Trade fixtures, fittings, utensils, etc.
(g) Furniture
(h) Life policies
(i) Stocks and shares
(j) Reversionary or other interests under wills.
(k) Other property, viz.-
Total as per list (H).
list (C)
Less estimated value of securities
Liabilities on bills discounted other than debtor's own acceptances for value as per list (D), viz.-
On accommodation bills as drawer, acceptor or indorser
On other bills as drawer or indorser.
Book debts as per list (I), viz.-
Good
Doubtful
Bad
$ 432
Estimated to produce.