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Insolvency Act, 1936 (Act No. 24 of 1936)

Schedules

First Schedule : Forms

Form C : Affidavit for proof of any claim

 

FORM C

 

AFFIDAVIT FOR THE PROOF OF ANY CLAIM OTHER THAN A CLAIM BASED ON A PROMISSORY NOTE OR OTHER BILL OF EXCHANGE (SECTION 44(4)).

 

 

In the Insolvent Estate of        __________________________________________

 

Name in full of creditor        __________________________________________

 

Address in full                         _________________________________________

 

Total amount of claim        _________________________ £ _______________

 

 

I, __________________________________________________declare under oath/

 

Solemnly and sincerely declare *

 

1) That ___________________________ , whose estate has been sequestrated, was at the date of sequestration, and still is, indebted to ___________________________________________ in the sum of ______________________________________________________________

for ______________________________________________________________

 

2) That the said debt arose in the manner and at the time set forth in the account hereunto annexed.

 

3) That no other person besides the said_______________________________

is liable (otherwise than as surety) for the said debt or any part thereof.

 

That I have/ the said _____________________________________ has * not, nor has any other person, to my knowledge on my/his * behalf received any security for the said debt or any part thereof, save and except † ______________________________________________________________

______________________________________________________________

 

 

 

Signature of declarant ___________________________

 

Sworn / Solemnly declared * before me on the _____day of __________________

at_______________________.

 

 

_____________________________________________

Commissioner of Oaths.

 

 

* Strike out inappropriate words according to the facts of the case.
Here insert nature, particulars and value of mortgage, pledge or other security.