CAP. 6]
Bankruptcy.
FORM 46.
PROOF OF DEBT. GENERAL FORM.
(Title.)
No. (a) of 19 [rule 109.]
Re (a)
I (b) of make oath and say—
(c) That I am in the employ of the under-mentioned creditor, and that I am duly authorized by to make this affidavit, and that it is within my own knowledge that the debt hereinafter deponed to was incurred, and for the consideration stated, and that such debt, to the best of my knowledge and belief, still remains unpaid and unsatisfied.
(d) That I am duly authorized, under the seal of the company hereinafter named, to make the proof of debt on its behalf.
That the said receiving order, viz., the day of 19, justly and truly indebted to (e) W at the date of the ? in the sum of dollars and cents for (f) by the* { as shown } for
You should attend carefully to these directions.
(a) Here insert the number of matter, and the name of debtor, as given on the notice of meeting.
(b) Fill in full name, address and occupation of deponent.
If proof made by creditor strike out clauses (c) and (d).
If made by clerk of creditor strike out (d).
If by agent or clerk of company strike out (c).
(e) Insert "me" or in case of a firm "me and C.D. and E.F. my co-partners trading as", or if by clerk, insert name, address and description of principal.
Debt : Contra : account indorsed hereon account hereto annexed, marked “A” which sum or any part thereof I say that I have not nor hath (g) or any person by (h) to my knowledge or belief for (h) order use had or received any manner of satisfaction or security whatsoever, save and except the following (i) —
Admitted to vote for the of : 19 + day Official Receiver.
NOTE THIS.
(f) State consideration, (18 Goods sold and delivered by me [and my said partner] to him [or them] at his [or their] request between the dates of [or moneys advanced by me in respect of the undermentioned bill of exchange], or as the case may be.
* Strike out the words not applicable.
(g) "my said partners or any of them" or "the above-named creditor", as the case may be.
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