STATEMENT OF AFFAIRS (Section three hundred and sixty three of the Act.)
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1 Annexure CM100 THE COMPANIES ACT, 1973 Annexure CM100 Master s eferene No. STATEMENT OF AFFAIS (Setion three hundred and sixty three of the At.) Name of ompany Date of winding-up order Name and address of liquidator Statement of affairs on the day of 20 the date of the winding-up order
2 STATEMENT OF AFFAIS (Setion three hundred and sixty three of the At.) I. As regards LIABILITIES Debts and liabilities (I) Unseured reditors and laimants as per List A (II) Seured and preferent reditors as per List B Estimated surplus (if any) after meeting liabilities of ompany, subjet to osts of liquidation The nominal amount of unpaid apital liable to be alled up is Capital issued and allotted:- Founders shares of per share Ordinary shares of per share Preferene shares of per share Partiulars of any other apital II. As regards Less unpaid alls estimated to be irreoverable Add defiieny to meet liabilities as above I, of being a diretor, and I, of being the seretary of the abovenamed ompany make oath/truly affirm and say that the above statement and several lists hereunto annexed, marked, are to the best of our knowledge and belief a omplete and true statement of the affairs of the said ompany on the day of 20 the date of the winding up order. Diretor Seretary
3 STATEMENT OF AFFAIS (Setion three hundred and sixty three of the At.) Creditors. ASSETS (a) Property as per List C (b) Book debts as per List D :- eoverable Doubtful Irreoverable Estimated to realise () Bills of exhange or other similar seurities as per List E :- Estimated to realise (d) Unpaid share apital as per List F :- Estimated to realise Estimated defiieny of assets to meet liabilities and osts of liquidation Contributories. Estimated surplus as above (if any), subjet to osts of liquidation TOTAL DEFICIENCY* The deponents have aknowledged that they know and understand the ontents of this affidavit/delaration Signed and sworn to/delared before me at this day of 20 Exempt from Stamp Duty Signature *If the Master so direts, this defiieny is to be explained by Statement G or in suh a manner as the Master may require.
4 LIST A UNSECUED CEDITOS The names must be numbered onseutively, reditors for 20 and upwards being plaed first. NOTES 1. If any reditor of the ompany is also a debtor thereof, but for an amount less than the amount of his laim against the ompany, the gross amount due to the reditor and the amount of his ounter-laim must be shown in the third olumn, and the balane only be inserted under the heading Amount of Debt, as follows:- Gross amount due to reditor Less ounter-laim Suh set-off must not be inluded in list D 2. Partiulars of any bills of exhange and promissory notes in possession of a reditor must be inserted under the heading emarks. 3. The names of any reditors who are also ontributories or alleged ontributories of the ompany, must be shown separately and desribed as suh at the end of the list. No. Name Address and Oupation Amount of Debt emarks
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6 - 6 - LIST B LIST OF SECUED AND PEFEENT CEDITOS The names must be arranged in alphabetial order and numbered onseutively No. Name of Creditor Oupation Address Amount Partiulars, Extent and Date of Seurity
7 LIST C POPETY Full partiulars of every desription of property not inluded in any other list are to be set forth herein. Full Statement and Nature of Property Estimated to ealise (a) Cash at bank (as per bank ertifiate attahed) (b) Cash in hand () Stok-in-trade at (d) Mahinery at (as per valuation attahed*) (as per valuation attahed*) (e) Trade fixtures, fittings, offie furniture, utensils, et. (f) Investments in stoks or shares (g) Loans for whih mortgage or other seurity held (h) Other property (exluding book debts, bills of exhange or unpaid alls) *The valuation must be made by a person approved by the Master State partiulars
8 LIST D DEBTS DUE TO THE COMPANY The names must be numbered onseutively. NOTE: If any debtor of the ompany is also a reditor thereof, but for an amount less than his indebtedness, the gross amount due to the ompany and the amount of the ounter-laim must be shown in the third olumn, and the balane only be inserted under the heading Amount of Debt, as follows:- Gross amount due to ompany Less ounter-laim Suh set-off must not be inluded in List A No. Name of Debtor Address and Oupation Amount of Debt eoverable Doubtful Irreoverable Partiulars of any seurities held for debt
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10 LIST E BILLS OF EXCHANGE, POMISSOY NOTES, ETC., ON HAND AND AVAILABLE AS ASSETS No. Name of Aeptor and Maker Address Amount Due Date Partiulars, Extent and Date of Seurity
11 LIST F UNPAID SHAE CAPITAL Number in Share egister Name of Shareholder Address and Oupation Number of Shares Held Amount due on Eah Share Total Amount Due Estimated to ealise
12 LIST F (ontinued) UNPAID SHAE CAPITAL Number in Share egister Name of Shareholder Address and Oupation Number of Shares Held Amount due on Eah Share Total Amount Due Estimated to ealise
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14 Statement G DEFICIENCY ACCOUNT (N.B. This aount is prepared only at the request of the Master.) (1) Defiieny Aount where the winding-up order has been made within three years of formation of the ompany. I. Gross profit (if any) arising from arrying on a business from date of formation of ompany to date of winding up order (as per trading aount annexed) II. eeipts (if any) during the said period from undermentioned soures :- Interest on loans Interest on deposits Transfer fees Amount paid on shares issued and subsequently forfeited (as per list annexed) III. Other reeipts (if any) during the said period not inluded under any of the above headings:- IV. Defiieny as per statement of affairs (Part II) Total amount to be aounted for
15 Statement G (ont.) DEFICIENCY ACCOUNT I. Expenditure in arrying on the business from date of formation of the ompany to date of winding-up order:- GENEAL EXPENDITUE Salaries Wages not harged in trading aount ent ates and taxes Legal expenses Commission Interest on loans Interest on debentures Misellaneous expenditure (as per list annexed) Amount due at Amount Date of windingup order Disharged II. Diretors fees from the date of formation of ompany to date of winding-up order III. Dividends delared during the said period IV. Losses and depreiation written off in the ompany s books:-* Irreoverable debts Losses on investments Depreiation of property Preliminary expenses V. Losses and depreiation not written off in the ompany s books, now written off by diretors :-* Irreoverable debts Losses on investments Depreiation of property Preliminary expenses VI. Other losses and expenses:- Total amount to be aounted for * Lengthy partiulars must be entered into a separate shedule. These figures must agree
16 Statement G DEFICIENCY ACCOUNT (ontinued.) (N.B. This aount is prepared only at the request of the Master.) (2) Defiieny Aount where the winding-up order has been made within three years of formation of the ompany. I. Exess (if any) of assets over apital and liabilities on the * day of, 20 as per the ompany s balane sheet (this and any previous balane sheets to be annexed) II. Gross profit (if any) arising from arrying on a business from the * day of, 20 to date of winding-up order (as per trading aount annexed) III. eeipts (if any) during the said period from the undermentioned soures:- Interest on loans Interest on deposits Transfer fees Amount paid on shares issued and subsequently forfeited (as per list annexed) IV. Other reeipts (if any) during the said period not inluded under any of the above headings V. Defiieny as per statement of affairs (Part II) Total amount to be aounted for
17 Statement G (ont.) DEFICIENCY ACCOUNT I. Exess (if any) of assets over apital and liabilities over assets on the * day of, 20 as per the ompany s balane sheet (this and any previous balane sheets to be annexed) II. Expenses of arrying on the business from the*, 20 to date of winding-up order:- day of GENEAL EXPENDITUE Salaries Wages not harged in trading aount ent ates and taxes Legal expenses Commission Interest on loans Interest on debentures Misellaneous expenditure (as per list annexed) Amount due at Amount Date of windingup order Disharged III. Diretor s fees from the* day of 20 to date of the winding-up order IV. Dividends delared during the said period V. Losses and depreiation from the* day of 20 to date of the winding-up order written off in the ompany s books:- Irreoverable debts Losses on investments Depreiation of property Preliminary expenses VI. Losses and depreiation not written off in the ompany s books, now written off by diretors :- Irreoverable debts Losses on investments Depreiation of property Preliminary expenses VII. Other losses and expenses:- Total amount to be aounted for * Three days before date of winding-up order. Lengthy partiulars must be entered into a separate shedule. These figures must agree
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