Form 66

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FORM NO. 66
[See Rule 151]

[Heading as in Form No. 1]

Company Petition No. ............... of 20.....

Affidavit of proof of debt


I, .............................. of etc, (full name, address and occupation of deponent
to be given) do solemnly affirm and slate as follows:--

1. The above-named company was, at the date of the order winding-up the
same* viz., the ............... day of ............... 20...... and still is, justly and truly
indebted to me [or to me and C.D., and E.F., my copartners in trade, or, as the
case may be.] in the sum of Rs. ............... for [here state consideration, e.g.,
goods sold and delivered by me/my firm to the said company between the
dates of ............... or monies advanced by me/my firm in respect of the under-
mentioned bill of exchange, or as the case may be], as shown by the account in
the schedule below.

2. In respect of the said sum or any part thereof, I say I have not, nor have my
partners or any of them, nor has any person, by my/our order, to my/our
knowledge or belief, for my/ our use, had or received any manner of
satisfaction or security whatsoever, save and except the following :--
[Here state the particulars of all securities held, and where the securities are on the
property of the company, assess the value of the same, and if any bills or other negotiable
securities be held specify them in the Schedule.]

[If the claim is made as a preferential claim, say so and set out the grounds on which the
preference is claimed.]

SCHEDULE

Bills of Exchange

Date Drawer Acceptor Amount Due date

Rs P.

Particulars of account referred to:--

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(Credit should be given for contra-accounts)

Date Consideration Amount Remarks

Rs. P. The vouchers (if


any) by which
the account can
be substantiated
should be set
out here

Solemnly, affirmed at ............................................on ...........................( day),


the ..................................day of.............................20 …….

Before me.

Commissioner. Deponent’s signature .

Notes: --

1. Bills of exchange or negotiable securities must be produced before the proof


can be admitted.

2. The proof cannot be admitted for voting at the first meeting unless it is
properly completed and lodged with the Official Liquidator before the time
named in the notice convening the meeting.

3. Where the affidavit is not by the creditor, but by some person authorized by
him, the deponent should state in a separate paragraph his authority for
making the affidavit and the means of his knowledge, and suitable alterations
should be made, in paragraphs 1 and 2 above, and the name, address and
description of the creditor should be set out in paragraph 1.
* [where before the presentation of the petition for winding-up, a resolution has been
passed by the company for voluntary winding-up, the date of the said resolution must be
substituted for the date of the winding-up order.]

_________

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