IN THE HIGH COURT IN MALAYA AT KUALA LUMPUR (CEMMERCIAL DIVISION) COMPANIES (WINDDING-UP) NO:___________ RE:____________ STATEMENT OF AFFAIRS Stateme

t !" a""a#$% ! t&e ''' (a) !" ''' *+', t&e (ate !" t&e -# (# .-/0 !$(e$1 (I) AS REGARDS CREDITORS

G$!% 2#a3#2#t#e% RM 7 Debts and liabilities, viz: (a)

L#a3#2#t#e%

E40e5te( t! $a 6

Unsecured creditors as per list A (State number) RM 7 Creditors fully secured, (not including debenture holders) as per list !sti"ated value of securities !sti"ated surplus Carried to list C alance to contra (d) RM 7

(b)

(c)

Creditors partly secured as per list C

#ess esti"ated value of securities !sti"ated to ran$ for dividend (d) #iabilities on bills discounted other than the co"panys o%n acceptances for value, as per list D &f %hich it is e'pected %ill ran$ for dividend &ther liabilities as per list ! &f %hich it is e'pected %ill ran$ for dividend (referential creditors for rates, ta'es, %ages, etc, as per list ) deducted contra #oan on debenture bonds, as per list * deducted contra !sti"ated surplus, if any, +,-- after "eeting liabilities of co"pany, sub.ect to cost of li/uidation

RM

(e) (f) (g)

A%%et% (a) (roperty as per list 0, (a) (b) (c) (d) (e) (f) (g) (h) (b) Cash at ban$ers Cash in hand 1toc$ in trade (esti"ated cost, +,--) ,achinery 2rade fi'tures, fittings, utensils, etc 3nvest"ents in shares, etc #oan on "ortgage &ther property, viz: RM 7

E40e5te( t! $a 6 RM 7

oo$ debts (debtors), as per list 3, viz: *ood Doubtful ad !sti"ated to produce

(c) (d)

ills of e'change, or other si"ilar securities on hand as per list 4 !sti"ated to produce

(e)

1urplus fro" securities in the hands of creditors fully secured as per contra (b) Unpaid calls (debtors), per list 5 !sti"ated to produce

ESTIMATED TOTAL ASSETS Deduct preferential creditors as per contra (f) !sti"ated a"ount available to "eet clai"s of debenture holders Deduct loans on debenture bonds secured on the assets of the co"pany as per contra (g) !sti"ated a"ount available to "eet unsecured creditors, sub.ect to cost of li/uidation !sti"ated deficiency of assets to "eet liabilities of the co"pany, sub.ect to cost of li/uidation

2he no"inal a"ount of unpaid capital liable to be called up is +,-- %hich is 6available to "eet the 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: : +, : !sti"ated 1urplus as above (if any) sub.ect to cost #i/uidation

)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 to be irrecoverable +,-2otal deficiency as e'plained in state"ent ;o<

Add deficiency to "eet liabilities as above

# -&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

3, (name and description of deponent) :"a$e oath or affir"; and say that the foregoing state"ent and the several lists hereunto anne'ed "ar$ed ( state marks) are, to the best of "y $no%ledge and belief, a full, true and co"plete state"ent of the affairs of the above= na"ed Co"pany, on the --- day of --- >?-, the date of the %inding=up order8

Dated the --- day of --- >?:1%orn or Affir"ed; on the --) day of --- >?- at --) :(2hrough the interpretation of (name));)

(Deponents signature)

efore "e

(Signature) ,agistrate

9&2!: 2he "agistrate is particularly re/uested, before s%earing the affidavit, to ascertain that the full na"e, address, and description of the deponent are stated, and to initial all crossings out or other alterations on the printed for"8 A deficiency in the affidavit in any of the above respects %ill entail its refusal by the court, and %ill necessitate its being re=s%orn8

LIST <A= UNSECURED CREDITORS (The names to be arranged in alphabetical order and numbered consecutively, creditors for RM100 and up ards being placed first) 9&2!1: >8 @hen there is a contra account against the creditor, less than the a"ount of his clai" against the Co"pany, the a"ount of the creditors clai" and the a"ount of the contra account should be sho%n in the third colu"n, and the balance only be inserted under the heading A"ount of debt, thus: RM 2otal a"ount of clai" #ess: Contra account 9o such set=off should be included in list 38 A8 B8 2he particulars of any bills of e'change and pro"issory notes held by a creditor should be inserted i""ediately belo% the na"e and address of such creditor8 2he na"e of any creditors %ho are also contributories, or alleged to be contributories, of the Co"pany "ust be sho%n separately, and described as such at the end of the list8 9a"e Address and occupation A"ount of debt Debt %hen contracted Consideration 7

9o

+,

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

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

N!

Name !" 5$e(#t!$

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

Am!/ t !" (e3t +, :

Date -&e 5! t$a5te( ,onth Cear

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/$#t) +, :

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

LIST <C= CREDITORS PARTLY SECURED (State hether also contributories of the company)
N! Name !" 5$e(#t!$ A(($e%% a ( !55/0at#! Am!/ t !" (e3t +, : Date -&e 5! t$a5te( ,onth Cear 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/$#t) +, :

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

LIST <D= LIA9ILITIES OF COMPANY ON 9ILLS DISCOUNTED OTHER THAN THEIR OWN ACCEPTANCES FOR VALUE A"ount e'pected to ran$ for dividend : +,

9o

Acceptors na"e, address and occupation

@hether liable as dra%er or indorser

Date %hen due

A"ount

0olders na"e, address and occupation (if $no%n) :

+,

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

LIST <E= OTHER LIA9ILITIES (!ull particulars of all liabilities not other ise scheduled to be given here ) 9o 9a"e of creditor or clai"ant Address and occupation A"ount of liability or clai" +, : Date %hen liability incurred 9ature of liability Consideration A"ount e'pected to ran$ against assets 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!/ t 0a)a32e # "/22 +, :

D#""e$e 5e $a 6# . "!$ (#>#(e ( +, :

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

LIST <G= LIST OF DE9ENTURE HOLDER (The names to be arranged in alphabetical order and numbered consecutively" Separate lists must be furnished of holders of each issue of debentures, should more than one issue have been made)
N! Name !" &!2(e$ A(($e%% RM Am!/ t 7 De%5$#0t#! !" a%%et% !>e$ -&#5& %e5/$#t) e4te (%

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

LIST H PROPERTY (Full particulars of every description of property not included in any other lists are to be set forth in this list)
F/22 %tateme t a ( at/$e !" 0$!0e$t) E%t#mate( 5!%t E%t#mate( t! 0$!(/5e

)ull state"ent and nature of property !sti"ated to produce (a) (b) (c) (d) (e) (f) (g) (h) Cash at ban$ers Cash in hand 1toc$ in trade, at (place) ,achinery, at (place)

!sti"ated

cost

2rade fi'tures, fittings, office furniture, utensils, etc 3nvest"ents in stoc$ or shares, etc #oans for %hich "ortgage or security held: (State particulars) &ther property, viz: (State particulars)

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

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 his indebtedness, the gross a"ount due to the co"pany, and the a"ount of the contra account should 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%#(e t#a2 a ( !55/0at#! G!!(

Am!/ t !" (e3t

F!2#! !" 2e(.e$ !$ !t&e$ 3!!6 -&e$e 0a$t#5/2a$% t! 3e "!/ ( 9a(

W&e 5! t$a5te(

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

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

D!/3t"/2

M! t&

Yea$

+,

+,

+,

+,

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

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$t#5/2a$% !" a ) 0$!0e$t) &e2( a% %e5/$#t) "!$ 0a)me t !" 3#22 !$ !te

RM

RM

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

LIST <K= UNPAID CALLS

C! %e5/t#>e !

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

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

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

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

Am!/ t !" 5a22 0e$ %&a$e / 0a#(

T!ta2 am!/ t (/e

E%t#mate( t! $ea2#Ae

+,

+,

+,

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

LIST <L= LIST OF FOUNDERSB SHARES

C! %e5/t#>e ! Re.#%te$ ! Name !" %&a$e&!2(e$ A(($e%% a ( !55/0at#! N!m# a2 am!/ t !" %&a$e N! !" %&a$e% &e2( Am!/ t 0e$ %&a$e 5a22e( /0 T!ta2 am!/ t 5a22e( /0

+,

+,

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

LIST <M= LIST OF ORDINARY SHARES

C! %e5/t#>e ! Re.#%te$ ! Name !" %&a$e&!2(e$ A(($e%% a ( !55/0at#! N!m# a2 am!/ t !" %&a$e N! !" %&a$e% &e2( Am!/ t 0e$ %&a$e 5a22e( /0 T!ta2 am!/ t 5a22e( /0

+,

+,

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

LIST <N= LIST OF PREFERENCE SHARES

C! %e5/t#>e ! Re.#%te$ ! Name !" %&a$e&!2(e$ A(($e%% a ( !55/0at#! N!m# a2 am!/ t !" %&a$e N! !" %&a$e% &e2( Am!/ t 0e$ %&a$e 5a22e( /0 T!ta2 am!/ t 5a22e( /0

+,

+,

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

LIST <O= (*) DEFICIENCY ACCOUNT (>) Deficiency Account %here %inding=up order "ade %ithin three years of for"ation of co"pany
3) *ross profit, if any, arising fro" carrying on business fro" date of for"ation of co"pany to date of %inding=up order, as per 2rading Account anne'ed +eceipts, if any, during sa"e period fro" under="entioned sources: 3nterest on loans 3nterest on deposits 2ransfer fees A"ount paid on shares issued and subse/uently forfeited (as per list anne'ed) 333) &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) 333) 3D) D) +, : 3) !'penditure in carrying on business fro" date of for"ation of co"pany to date of %inding=up order, viz: (#ive details) *eneral e'penditure: 1alaries @ages not charged in 2rading Account +ent +ates E ta'es #a% costs Co""ission 3nterest on loans 3nterest on debentures ,iscellaneous e'penditure, as per details anne'ed Directors fees fro" date of for"ation of co"pany to date of %inding=up order Dividends declared during sa"e period #osses and depreciation %ritten off in co"panys boo$s: ad debts #osses on invest"ents Depreciation of property (reli"inary e'penses D3) #osses and depreciation not %ritten off in co"panys boo$s, no% %ritten off by the directors: ad debts #osses on invest"ents Depreciation of property (reli"inary e'penses D33) &ther losses and e'penses +, :

33)

33)

3D)

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

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

9&2!: (>) (A) @here particulars are nu"erous they should be inserted in a separate schedule8 should

2he figures of the total a"ount accounted for at the botto" of the colu"ns agree8 (Signature)

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

LIST <O= (C)

DEFICIENCY ACCOUNT (A) Deficiency Account %here %inding=up order "ade "ore than three years after for"ation of the co"pany
3) !'cess of assets over capital and liabilities on the --- day of --- >?-, if any, as per co"panys balance sheet8 (2his and any previous balance sheets to be anne'ed or handed to the &fficial +eceiver) *ross profit, if any, arising fro" carrying on business fro" the --- day of --- >?- to the date of %inding=up order as per 2rading Account anne'ed +eceipts, if any, during sa"e period fro" under="entioned sources: 3nterest on loans 3nterest on deposits 2ransfer fees A"ounts paid on shares issued and subse/uently forfeited (as per lists anne'ed) 3D) &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 on the --- day of --- >?-, if any, as per co"panys balance sheet8 (2his and any previous balance sheets to be anne'ed or handed to the &fficial +eceiver) !'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% costs Co""ission 3nterest on loans 3nterest on debentures ,iscellaneous e'penditure (as per details anne'ed) 333) Directors fees fro" the --- day of -->?- to the date of %inding=up order +, :

33)

33)

333)

D)

3D) Dividends declared during the sa"e period D) #osses and depreciation fro" the --- day of --- >?- %ritten off in co"panys boo$s, viz: ad debts #osses on invest"ents Depreciation of property (reli"inary e'penses D3) #osses and depreciation not %ritten off in co"panys boo$s, no% %ritten off by the directors: ad debts #osses on invest"ents Depreciation of property (reli"inary e'penses D33) &ther losses and e'penses

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

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

9&2!: (>) (A) (B) 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 2he figures of the total a"ount accounted for at the botto" of the colu"ns should agree8

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

(Signature)