IN THE HIGH COURT IN MALAYA AT . COMPANIES WINDING-UP No : ..OF .. In the matte o!

the Com"an#e$ A%t& '()* an+ In the matte o! PROOF OF DEBT GENERAL FORM
I, (a) I/C No. make oath (solemnly, sincerely and truly affirm) and say : (b) That I am in the employ of the under-mentioned creditor, and that I am duly authori ed by to make this affida!it, and that it is "ithin my o"n kno"led#e that the debt herein after deposed to "as incurred and for the consideration stated, and that such debt, to the best of my kno"led#e and belief, still remains unpaid and unsatisfied. (c) That I am duly authori ed, under the seal of the Company herein after named, to make the proof of debts on its behalf. $. That the abo!e named Company "as, at the date of the order for %indin#-&p the same, !i : the day of indebted to (d) for (e) endorsed herein, or by the follo"in# account, !i : sum or any part thereof I say that I ha!e not nor hath (f) or any person by (#) (#) security "hatsoe!er, sa!e and e,cept the follo"in# (h): -C./0&1/ Date Drawer Acceptor Amount Due Date order to my kno"led#e or belief for used had or recei!ed any manner of satisfaction or in the sum of *+ as sho"n by the account for "hich '( and still is )ustly and truly of

-"orn or 2ffirmed at (-i#nature of 0eponent) In the -tate of This 333. day of 33.3..33'( 3.3 4efore me,

Note:-: The " oo! %annot ,e a+m#tte+ !o -ot#n. at the F# $t Meet#n. /n0e$$ #t #$ " o"e 01 %om"0ete+ an+ 0o+.e 2#th the O!!#%#a0 Re%e#-e ,e!o e the t#me name+ #n the not#%e %on-en#n. the meet#n..

INDORSED ACCOUNT
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De"onent6$ S#.nat/ e

YOU SHOULD ATTEND CAREFULLY TO THESE DIRECTIONS 3a4 F#00 #n !/00 name& a++ e$$ an+ o%%/"at#on o! +e"onent. I! " oo! ma+e ,1 % e+#to $t #5e o/t %0a/$e$ 3,4 an+ 3%4. I! ma+e ,1 %0e 5 o! % e+#to $t #5e o/t 3%4. I! ,1 %0e 5 o a.ent o! the %om"an1 $t #5e o/t 3,4. In$e t 7me an+ to C.D. an+ E.E.& m1 %o-"a tne $ #n t a+e 3#! an148 o & #! ,1 %0e 5 o a.ent #n$e t name& a++ e$$ an+ +e$% #"t#on o! " #n%#"a0. State %on$#+e at#on 3a$ .oo+$ $o0+ an+ +e0#-e e+ ,1 me 3an+ m1 $a#+ "a tne 4 to the %om"an1 ,et2een the +ate$ o! 3o mone1$ a+-an%e ,1 me #n e$"e%t o! the /n+e ment#one+ ,#00 o! e9%han.e4 o a$ the %a$e ma1 ,e4. 7M1 $a#+ "a tne $ o an1 o! them :o 6 the a,o-e name+ % e+#to 8 3a$ the %a$e ma1 ,e4. 7M18 o 7O/ 8 o 7the# 8 o 7th#$8 3a$ the %a$e ma1 ,e4. 3He e $tate to the "a t#%/0a $ o! a00 $e%/ #t#e$ he0+& an+ 2he e the $e%/ #t#e$ a e on the " o"e t1 o! the %om"an1 a$$%e$$ the -a0/e o! the $ame& an+ #! an1 ,#00$ o othe ne.ot#a,0e $e%/ #t#e$ ,e he0+& $"e%#!1 them #n the $%he+/0e4.

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