B 22
[Subsidiary]
CAP. 6]
Bankruptcy (Forms) Rules
[1977 Ed.
No.
B
CREDITORS FULLY SECURED
Name Address
of and Amount credi-
tor occupa-
tion of debt
Date when contracted
Partic-
Con-
sidera-
tion
Date
Esti-
Esti-
mated mated
ulars value surplus
when
of secu-
of
from
rity given
SECU-
Secu-
rity rity
$ $ $
Dated this day of
C
CREDITORS PARTLY SECURED
(Signature) .19
Date
Esti-
Month
Name Address
when
Partic-
mated Balance
No.
tor of and Amount credi-
occupa-| of debt
tion contracted
Con-
sidera-
tion
and
ulars value
of debt
of secu
year
when
rity
SOCU-
un-
secured
Month Year
given
rity
$ $
No.
Dated this day of
D
(Signature) , 19
LIABILITIES OF DEBTOR on bills discounted other than his own acceptances for value
Wheth-
er
Amount
Acceptor's
liable Date
name, address and occupation
drawer
or en-
dorser
as
when
due Accom-
modation bills
Other bills
$
Dated this
Holder's
name, address and occupation (if known)
Amount expected to rank
against estate for dividend
day of
19
(Signature)