1977 Ed.]
Bankruptcy (Forms) Rules
FORM 28
STATEMENT OF AFFAIRS
(Title.)
[CAP. 6
B 19
[Subsidiary]
(s. 18(1); rules 81, 150.)
To the Debtor,
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, viz, the
19
day of
Such sheets, when filled up, will constitute your Statement of Affairs, and must be verified by oath, declaration or affirmation.
* Sheet "L" should be substituted for any one or more of such of the sheets named as will have to be returned blank.
Gross Liabilities (as stated and estimated by debtor)
Expected to produce
JUBI O
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 thereof
Less amount carried to sheet (C)
Balance thereof to contra
Creditors partly secured as per list (C)
Less estimated value of securities
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)
Liabilities on bills discounted other than debtor's OWN acceptances for value as per list (D), viz.-
On accommodation bills as drawer, acceptor or endorser
On other bills as drawer or endorser
Book debts as per list (I), viz.—
Good
Doubtful
Bad..
$
Estimated to produce