STATEMENT OF AFFAIRS AS AT…….

Assets not specifically Pledged:

Est. Realisable

Values (Sh)

Balance at bank

xx

Investments

xx

Trade debtors

xx

Stock-in-trade

xx

Fixed Assets

xx

xx

Assets specifically

pledged

Est. Realisable

Values (sh)

Due to secured

crs (sh)

Deficiency unsecured (sh)

Surplus to last (sh)

Asset 1

xx

xx

xx

xx

Asset 2

xx

xx

xx

xx

xx

xx

xx

xx

Estimated Surplus from assets specifically pledged

xx

ESTIMATED TOTAL ASSETS

xx

Gross

Liabilities

Liabilities (sh)

xx

Secured creditors (Fixed charge)

xx

Preferential creditors

(xx)

Estimated surplus for unsecured creditors and

xx

Creditors secured by a floating charge.

xx

Secured creditors (Floating charge)

(xx)

Estimated surplus for unsecured creditors

xx

Unsecured creditors:

xx

     -Trade creditors

xx

xx

     - Bank overdraft

xx

xx

     - Contingent liabilities

xx

xx

     - Unsecured deficiency on pledged assets

xx

xx

xx

Estimated deficiency as regards unsecured creditors

(xx)

Issued and called up share capital

(xx)

ESTIMATED DEFICIENCY AS REGARDS MEMBERS

xx

Items contributing to deficiency (or reducing surplus)

Shs

shs

1)       Excess of capital and liabilities over assets 3 years

       before winding up (if any)

xx

2)       Dividends and bonuses declared

xx

3)       Net trading losses

xx

4)       Losses other than trading losses written off

xx

5)       Estimated realization losses

xx

6)       Other items contributing to deficiency

xx

xx

Items reducing deficiency (or contributing to surplus)

7)       Excess of assets over capital and liabilities 3 years

       before winding up order (if any)

xx

8)       Net trading profits

xx

9)       Profits and income other than trading profits

xx

10)   Other items reducing deficiency or contributing surplus

xx

xx

DEFICIENCY AS PER STATEMENT OF AFFAIRS

xx