STATEMENT OF AFFAIRS AS AT

(DATE), DATE OF RECEIVING ORDER

Gross Liabilities

Liabilities as stated & estimated by debtor

Expected to rank

Assets as stated & estimated by debtor

Estimated to produce

Sh ‘000’

Sh ‘000’

Sh ‘000’

Sh ‘000’

x

Unsecured creditors

Cash at bank

x

x

Creditors fully secured

x

Cash in hand

x

Less value of security

(x)

Stock-in-trade

x

Surplus to contra

x

Machinery

x

x

Creditors partly secured

x

Trade fixtures

x

Less value of security

(x)

Furniture

x

x

Life policies

x

x

Liabilities on bills discounted

x

Stocks, shares and other investments

x

Contingent and other liabilities

x

Bank debts:  Good

x

x

Preferential creditors

               : Doubtful

x

deducted per contra

               : Bad

x

x

Estimated to produce

x

Bills of exchange

x

Estimated to produce

x

Surplus from secured Creditors

per contra

x

x

Deduct preferential

(x)

Creditors per contra

x

Deficiency as per

Deficiency a/c

x

xx

xx

xx

DEFICIENCY (SURPLUS) A/C

Sh ‘000’

Sh ‘000’

Excess of assets over liabilities

Losses from Trading

x

(One year before receiving order)

x

Estimated loss on realization of

Excess of private assets over

Assets

x

Liabilities (one year before receiving

Drawings

x

Order)

x

Net profits from the business for the

Period under review

x

Other receipts-gifts legacies etc

x

Deficiency as per statement of affairs

x

xx

xx