1964_COMPANIES_(FORMS)_REGULATIONS — Page 58

1984 Ed.]

Companies (Forms) Regulations

[CAP. 32

FORM XIB(ii)

In the High Court

In the matter of

Name of company

COMPANIES ORDINANCE

(Chapter 32)

Statement as to affairs (affidavit )

Pursuant to sections 300A(1)(b) and 300B

and in the matter of the Companies Ordinance

Statement as at the

being the date of the appointment of the Receiver

We

of

and

of

B 59

[Subsidiary]

L.N. 168/84.

Please do not write in this binding margin.

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

Company number

Please refer to Notes.

day of

19

a director of the above-named company

the secretary thereof make oath and say as follows: That the statement made overleaf and the several lists hereto annexed marked are to the best of our knowledge and belief a full, true and complete statement as to the affairs of the above-named company on the

day of.

being the date of the

appointment of the Receiver.

19.

*Note the several lists

annexed are not exhibits to the Affidavit.

Sworn at

this

day of

before me

A Commissioner for Oaths**

Signatures

19.

Presentor's name, address and reference (if any)

For official use

**Or Notary Public or

Justice of the Peace

or Solicitor having

the powers conferred on a Commissioner for Oaths. The Commissioner is requested to read note 2