Gross liabilities.
Of Liabilities (as stated and estimated by debtor).
Bankruptcy.
Expected to rank.
Assets (as stated and estimated by debtor).
Of which it is expected will rank against the estate for dividend
Contingent or other liabilities as per list (E)
Estimated to produce.
Bills of exchange, or other similar securities on hand as per list (J)....$
Estimated to produce.
of which it is expected will rank against the estate for dividend $
Surplus from securities in the hands of creditors fully secured (per contra)
Creditors for rent, etc., recoverable by distress as per list (F)
Creditors for rates, taxes, wages, etc., payable in full as per list (G)
Deduct Creditors for distrainable rent and for preferential rates, taxes, wages, bailiff's charges, etc. (per contra)
Deducted contra
† Surplus explained in statement (K)
† Deficiency explained in statement (K)
I of make oath and say that the above statement and the several lists hereunto annexed marked are, to the best of my knowledge and belief, a full, true and complete statement of my affairs on the date of the above-mentioned receiving order made against me.
Sworn at the Courts of Justice, Hong Kong, this day of 19
Before me,
A Commissioner etc.
(Signature)
433
69
Estimated to produce.
†Strike out words which do not apply.
[CAP. 6