1984 Ed.]

Companies (Forms) Regulations

[CAP. 32

LIST 'C' (consisting of ... pages)

Statement of Affairs

Preferential creditors for rates, taxes, salaries, wages and otherwise

The names to be arranged in alphabetical order and numbered consecutively

No. Name of creditor Address and occupation Nature of claim Period during which claim accrued Due when due Amount of claim Signed Date Amount not payable in full Balance carried to List 'E' S S C S C B 53 [Subsidiary]

Please do not write in this binding margin.

Please complete legibly, preferably in black type, or bold block lettering.

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