Insolvensi Borang Penyataan Hal Ehwal

8/14/2019 Insolvensi Borang Penyataan Hal Ehwal

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IN THE HIGH COURT IN MALAYA AT KUALA LUMPUR(CEMMERCIAL DIVISION)

COMPANIES (WINDDING-UP) NO:___________ RE:____________

STATEMENT OF AFFAIRS

Statemet !" a""a#$% ! t&e ''' a !" ''' *+', t&e ate !" t&e ##.-/0 !$e$1

(I) AS REGARDS CREDITORS

G$!%2#a3#2#t#e% L#a3#2#t#e%

E40e5tet! $a6

RM 7 Debts and liabilities, viz:

(a) Unsecured creditors as per list ‘A’(State number )

(b) Creditors fully secured,(not including debenture holders)as per list ‘’

!sti"ated value of securities!sti"ated surplusCarried to list ‘C’alance to contra (d)

(c) Creditors partly secured as per list ‘C’

#ess esti"ated value of securities !sti"ated to ran$ fordividend

(d) #iabilities on bills discounted other than theco"pany’s o%n acceptances for value, as per list‘D’ &f %hich it is e'pected %ill ran$ for dividend

(e) &ther liabilities as per list ‘!’ &f %hich it is e'pected%ill ran$ for dividend

(f) referential creditors for rates, ta'es, %ages, etc, asper list ‘’ deducted contra

(g) #oan on debenture bonds, as per list ‘*’ deductedcontra !sti"ated surplus, if any, +-- after"eeting liabilities of co"pany, sub.ect to cost ofli/uidation

RM 7

RM 7

RM 7



A%%et%E40e5tet! $a6

(a)

(b)

(c)

(d)

(e)

roperty as per list ‘0’,

(a) Cash at ban$ers

(b) Cash in hand(c) 1toc$ in trade (esti"ated cost, +--)(d) achinery(e) 2rade fi'tures, fittings, utensils, etc(f) 3nvest"ents in shares, etc(g) #oan on "ortgage(h) &ther property, viz:

oo$ debts (debtors), as per list ‘3’, viz:

*oodDoubtfulad

!sti"ated to produce

ills of e'change, or other si"ilar securities on hand as perlist ‘4’


1urplus fro" securities in the hands of creditors fullysecured as per contra (b)

Unpaid calls (debtors), per list ‘5’


RM 7

RM 7

ESTIMATED TOTAL ASSETS

Deduct preferential creditors as per contra (f)!sti"ated a"ount available to "eet clai"s of debentureholders

Deduct loans on debenture bonds secured on the assets ofthe co"pany as per contra (g)

!sti"ated a"ount available to "eet unsecured creditors, sub.ect to cost ofli/uidation

!sti"ated deficiency of assets to "eet liabilities of the co"pany, sub.ect tocost of li/uidation

2he no"inal a"ount of unpaid capital liable to be called up is +-- %hich is 6available to "eetthe above deficiency and or 6and7 charged to debenture holders7 or as the cas "ay be8



STATEMENT OF AFFAIRS (CONTINUED)II 8 AS REGARD CONTRI9UTORIES

Capital issued and allotted, viz:

ounders’ shares of +-- per share(-- shareholders)

3ssued as fully or partly; paid up A"ount called up at +-- per

share, as per list ‘#’

&rdinary shares of +-- per share (-- shareholders) 3ssued as fully paid A"ount called up at +-- per share, as per

list ‘’

reference shares of +-- per share (-- shareholders)3ssued as fully paid A"ount called up at +-- per share, as per list‘9’

A"ount, if any, paid in advance of call #ess unpaid calls esti"ated tobe irrecoverable +--

Add deficiency to "eet liabilities as above

+ + !sti"ated 1urplusas above (if any)

sub.ect to cost#i/uidation

2otal deficiency ase'plained instate"ent ;o<

&e 5a0#ta2 #% #%%/e 0a# /0 t&e "!$m %&!/2 3e a2te$e a55!$#.2 A 0a$t#5/2a$% !" a !t&e$ 5a0#ta21







LIST <9=CREDITORS FULLY SECURED (NOT INCLUDING DE9ENTURE HOLDERS)

N! Name !"5$e#t!$

A$e%%a

!55/0at#!

Am!/t !"e3t

Date &e5!t$a5te

C!%#e$at#! Pa$t#5/2a$% !"

%e5/$#t

Date&e

.#>e

E%t#mate>a2/e !"

%e5/$#t

E%t#mate%/$02/% "$!m

%e5/$#tonth ear

+ + +

Dated the --- day of --- >?-

(Signature)



LIST <C=CREDITORS PARTLY SECURED

(State hether also contributories of the company )

N! Name !"5$e#t!$

A$e%%a

!55/0at#!

Am!/t !"e3t

Date &e5!t$a5te

C!%#e$at#!

Pa$t#5/2a$%!" %e5/$#t

Date&e.#>e

E%t#mate >a2/e !"%e5/$#t

E%t#mate%/$02/% "$!m

%e5/$#tonth ear

+ + +


(Signature)



LIST <D=LIA9ILITIES OF COMPANY ON 9ILLS DISCOUNTED OTHER THAN THEIR OWN ACCEPTANCES

FOR VALUE

9o Acceptor’s na"e,

address andoccupation

@hether liable

as dra%er orindorser

Date %hen

due

A"ount 0older’s na"e, address

and occupation(if $no%n)

A"ount

e'pected toran$ fordividend

+ +


(Signature)



LIST <E=

OTHER LIA9ILITIES

(!ull particulars of all liabilities not otherise scheduled to be given here )

9o 9a"e of

creditor orclai"ant

Address and

occupation

A"ount of

liability orclai"

Date %hen

liabilityincurred

9ature of

liability

Consideration A"ount e'pected

to ran$ againstassets for dividend

+ +

Dated the --- day of --- >?-(Signature)



LIST <F=PREFERENTIAL CREDITORS FOR RATES, TA?ES, SALARIES AND WAGES

N! Name !"5$e#t!$

A$e%% a!55/0at#!

Nat/$e !"52a#m

Pe$#! /$#.&#5& 52a#m

a55$/e /e

Date &e /e Am!/t !" 52a#m Am!/t0aa32e # "/22

D#""e$e5e $a6#."!$ #>#e

+ +




LIST <G=LIST OF DE9ENTURE HOLDER

(The names to be arranged in alphabetical order and numbered consecutively" Separatelists must be furnished of holders of each issue of debentures, should more than one issue

have been made)

N! Name !" &!2e$ A$e%% Am!/t De%5$#0t#! !" a%%et% !>e$ &#5&%e5/$#t e4te%

RM 7




LIST HPROPERTY

(Full particulars of every description of property not included in any other lists are tobe set forth in this list )

F/22 %tatemet a at/$e !" 0$!0e$t E%t#mate 5!%tE%t#mate t! 0$!/5e

ull state"ent and nature of property !sti"ated cost!sti"ated to produce

(a) Cash at ban$ers

(b) Cash in hand

(c ) 1toc$ in trade, at ( place)

(d ) achinery, at ( place)

(e) 2rade fi'tures, fittings, office furniture, utensils, etc

(f ) 3nvest"ents in stoc$ or shares, etc

(g ) #oans for %hich "ortgage or security held:(State particulars)

(h) &ther property, viz: (State particulars)




LIST <I=DE9TS DUE TO THE COMPANY

(The names to be arranged in alphabetical order, and numbered consecutively )

9&2!:

3f any debtor to the co"pany is also a creditor, but for an a"ount less than hisindebtedness, the gross a"ount due to the co"pany, and the a"ount of the contra accountshould be sho%n in the third colu"n, and the balance only is to be inserted under the heading‘A"ount of debt’ this:

RM 7

Due to co"pany :

#ess: Contra Account :

N! Name Re%#et#a2a

!55/0at#!

Am!/t !" e3t F!2#! !" 2e.e$ !$ !t&e$3!!6 &e$e 0a$t#5/2a$%

t! 3e "!/

W&e 5!t$a5te E%t#mate t!0$!/5e

Pa$t#5/2a$% !"a %e5/$#t#e%&e2 "!$ e3t

G!! D!/3t"/2 9a M!t& Yea$

+ + + +




LIST <@=9ILLS OF E?CHANGES, PROMISSORY NOTES ETC ON HAND AVAILA9LE AS

ASSETS

N! Name !"a55e0t!$ !" 3#22

!$ !te

A$e%% a!55/0at#!

Am!/t !" 3#22 !$!te

Date &e/e

E%t#mate t!0$!/5e

Pa$t#5/2a$% !" a0$!0e$t &e2 a%

%e5/$#t "!$0amet !" 3#22 !$

!te

RM 7 RM 7




LIST <K=UNPAID CALLS

C!%e5/t#>e!

N/m3e$ # %&a$e$e.#%te$

Name !"%&a$e&!2e$

A$e%% a!55/0at#!

N/m3e$ !"%&a$e &e2

Am!/t !" 5a220e$ %&a$e

/0a#

T!ta2am!/t /e

E%t#mate t!$ea2#e

+ + +

Dated the --- day of --- >?- (Signature)



LIST <L=LIST OF FOUNDERSB SHARES

C!%e5/t#>e ! Re.#%te$ ! Name !"%&a$e&!2e$

A$e%% a!55/0at#!

N!m#a2am!/t !"

%&a$e

N! !" %&a$e%&e2

Am!/t 0e$%&a$e 5a22e

/0

T!ta2 am!/t5a22e /0

+ +




LIST <M=LIST OF ORDINARY SHARES


A$e%% a!55/0at#!

N!m#a2am!/t !"

%&a$e

N! !" %&a$e%&e2

Am!/t 0e$ %&a$e5a22e /0

T!ta2 am!/t5a22e /0

+ +


(Signature)



LIST <N=LIST OF PREFERENCE SHARES


A$e%% a!55/0at#!

N!m#a2am!/t !"

%&a$e

N! !" %&a$e%&e2

Am!/t 0e$ %&a$e5a22e /0

T!ta2 am!/t5a22e /0

+ +




LIST <O= (*)

DEFICIENCY ACCOUNT

(>) Deficiency Account %here %inding=up order "ade %ithin three years of for"ation ofco"pany

3) *ross profit, if any, arising fro" carrying onbusiness fro" date of for"ation of co"pany todate of %inding=up order, as per 2rading

Account anne'ed33) +eceipts, if any, during sa"e period fro"

under="entioned sources:

3nterest on loans3nterest on deposits2ransfer fees

A"ount paid on shares issued andsubse/uently forfeited(as per list anne'ed)

333) &ther receipts, if any, during sa"e period notincluded under any of the above headings, viz:(#ive details)

3) Deficiency as per state"ent of affairs (art 33)

+ 3) !'penditure in carrying on business fro" date

of for"ation of co"pany to date of %inding=uporder, viz:(#ive details)

33) *eneral e'penditure:

1alaries@ages not charged in 2rading Account+ent+ates E ta'es

#a% costsCo""ission3nterest on loans

3nterest on debenturesiscellaneous e'penditure, as per detailsanne'ed

333) Directors’ fees fro" date of for"ation ofco"pany to date of %inding=up order

3) Dividends declared during sa"e period

) #osses and depreciation %ritten off inco"pany’s boo$s:

ad debts#osses on invest"entsDepreciation of propertyreli"inary e'penses

3) #osses and depreciation not %ritten off inco"pany’s boo$s, no% %ritten off by thedirectors:


33) &ther losses and e'penses

+

T!ta2 am!/t a55!/te "!$: T!ta2 am!/t a55!/te "!$:

9&2!:

(>) @here particulars are nu"erous they should be inserted in a separate schedule8

() 2he figures of the total a"ount accounted for at the botto" of the colu"ns shouldagree8


LIST <O= ()



DEFICIENCY ACCOUNT

() Deficiency Account %here %inding=up order "ade "ore than three years after for"ation ofthe co"pany

3) !'cess of assets over capital and liabilities onthe --- day of --- >?-, if any, as perco"pany’s balance sheet8 (2his and anyprevious balance sheets to be anne'ed orhanded to the &fficial +eceiver)

33) *ross profit, if any, arising fro" carrying onbusiness fro" the --- day of --- >?- tothe date of %inding=up order as per 2rading

Account anne'ed

333) +eceipts, if any, during sa"e period fro"under="entioned sources:

3nterest on loans3nterest on deposits2ransfer fees

A"ounts paid on shares issued andsubse/uently forfeited (as per lists anne'ed)

3) &ther receipts, if any, during sa"e period not

included under any of the above headings, viz:(#ive details)

) Deficiency as per state"ent of affairs (art 33)

+

3) !'cess of capital and liabilities over assets onthe --- day of --- >?-, if any, as perco"pany’s balance sheet8 (2his and anyprevious balance sheets to be anne'ed orhanded to the &fficial +eceiver)

33) !'penses of carrying on business fro" the--- day of --- >?- to the date of%inding=up order, viz:

*eneral e'penditure:1alaries@ages not charged in 2rading Account+ent+ates and ta'es#a% costsCo""ission3nterest on loans3nterest on debenturesiscellaneous e'penditure (as per detailsanne'ed)

333) Directors’ fees fro" the --- day of --->?- to the date of %inding=up order

3) Dividends declared during the sa"e period

) #osses and depreciation fro" the --- dayof --- >?- %ritten off in co"pany’s boo$s,viz:

ad debts#osses on invest"ents

Depreciation of propertyreli"inary e'penses

3) #osses and depreciation not %ritten off inco"pany’s boo$s, no% %ritten off by thedirectors:


33) &ther losses and e'penses

+

T!ta2 am!/t a55!/te "!$: T!ta2 am!/t a55!/te "!$:

9&2!:

(>) 2he dates "entioned above need to be of at least three years before the date of the %inding=up order8

() @here particulars are nu"erous they should be inserted in a separate schedule8(B) 2he figures of the total a"ount accounted for at the botto" of the colu"ns should agree8


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