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Statement of affairs under section 274(1)

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.... Solemnly affirmed at Before me. .......... this............... day of ..................... Signature(s) Commissioner for Oaths. The Commissioner is particularly requested, before swearing the affidavit, to ascertain that the full name, address and description of the deponent are stated, and to initial any crossing out or other alterations in the printed form. A deficiency in the affidavit in any of the above respects will entail its refusal by the Tribunal, and will necessitate its being re-sworn. Note - The several lists annexed are not exhibits to the affidavit. STATEMENT OF AFFAIRS AND LISTS TO BE ANNEXED Statement as to the affairs of ............. Ltd., on the ............. day of ...............20........., showing assets at estimated realisable values and liabilities expected to rank :- Assets not specifically pledged (as per List 'A') Balance at bank Cash in hand Marketable Securities Bills Receivable Trade Debtors Loans and Advances Unpaid Calls Stock in Trade Work in progress Freehold property, Land & Buildings Leasehold property Plant & Machinery Furniture, Fittings, Utensils, etc. Investments other than marketable securities Livestock Veh....

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....ect to the following notes:- (1) (f) there is no unpaid capital liable to be called up, or (g) the nominal amount of unpaid capital liable to be called up is Rs.............estimated to produce R......... which is/is not charged in favour of debenture holders [strike out (f) or (g)] (2) The estimates are subject to costs of the winding up and to any surplus or deficiency on trading pending realisation of assets. LIST 'A' - ASSETS NOT SPECIFICALLY PLEDGED Statement of Affairs: List 'A' Full particulars of every description of property not specifically pledged and not included in any other list are to be set forth in this list. Full statement and nature of property State name of bankers Balance at Bank State nature State nature Signature: Cash in hand Marketable Securities. Viz..... Bills Receivable (as per Schedule 1) Trade Debtors (as per Schedule II) Loans & Advances (as per Schedule III) ... Unpaid calls (as per Schedule IV) ...Stock in Trade (as per Schedule V)... ...Work in Progress Freehold property, viz, *** Leasehold property. viz Plant and Machinery, viz., Furniture, Fittings, Utensils, etc. Patents, Trade Marks, etc., viz., Investments other....

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....e VI to List 'A' Consecutive No. in No. shares Name of shareholder Address Nature and particulars Amount due Securities Serial held, if no. in register of debt any, for Schedule the debt I,II or III, Signature: Rs. as the case may be where the debt is included Dated...20.... LIST B-ASSETS SPECIFICALLY PLEDGED AND CREDITORS FULLY OR PARTLY SECURED (Not including debentures-holders secured by a floating charge) The names of the secured creditors are to be shown against the assets on which their claims are secured, numbered consecutively, and arranged in alphabetical order as far as possible. Statement of Affairs: List 'B' Particula rs of Date when Estimate No d value. Name of Address and Amou Date Considerati Balance nt of assets securi of credito occupati Debt when contract on of debt Esimate d unsecur specifica ty security rs on ed ed carried surplus from security lly given pledged Rs Rs to list "E" Rs Rs Signature: Dated 20.. *All assets specifically mortgaged, pledged, or otherwise given as security should be set out: goods given as security but in possession of the company and goods not in p....

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....LDERS The names to be arranged in alphabetical order and numbered consecutively Statement of Affairs: List 'G' Consecutive Register no. No. Name of Shareholder Address Nominal amount of share No. of Amount shares held per share called up Rs Total amount called up Rs Signature: Dated......20... LIST 'H' -DEFICIENCY OR SURPLUS ACCOUNT Statement of Affairs: List 'H' The period covered by this Account must commence on a date not less than 3 years of the date of presentation of the winding up petition or, if the company has not been incorporated for the whole period, the date of formation of the company, unless the Tribunal otherwise agrees. Items contributing to deficiency (or reducing surplus):- 1. Excess (if any) of Capital and Liabilities over Assets on the........... 20...... as shown by balance-sheet (copy annexed) ..... 2. 3. Net dividends and bonuses declared during the period from........ 20......to the date of the statement. Net trading losses(after charging items shown in note below) for the same period. 4. Losses other than trading losses written off or for which provisi- on has been made in the books during the same period (give- par....