Click on the link below to download your claim form.
Claim Form (right click to save)
Please complete the form and return the original to us at your earliest convenience
For Post use address : P O Box 1337 Fontainebleau 2032
or delivery use: 1st Floor, 292 Surrey Avenue, Randburg
Notes for completion of claim forms (right click to save)
NOTES FOR COMPLETION OF CLAIM FORMS
- Completion and Signature
The Commissioner of Oaths must print his full name and business address below his signature and state his designation and the area for which he holds his appointment or by office held by him if he holds his appointment ex officio.
Alterations must be initialed by declarant and Commissioner of Oaths.
If security is claimed, then the amount at which the creditor values such security must be inserted. A secured creditor who relies upon his security should state that fact on the Affidavit above the signature of the Declarant. (See 2.5 below).
- Promissory Notes, etc.
Where the claim is in respect of Promissory Notes, Bills of Exchange or Cheques, the appropriate Affidavit form should then be completed which can be found on the reverse side of the "OPEN ACCOUNT" Affidavit and any Bills, Notes or Cheques must be attached to the claim. (See 2.2 below).
2. SUPPORTING VOUCHERS
- Goods supplied on Open Account
A detailed Statement as per attached, supporting the Affidavit must be attached to the claim, showing the monthly total and a brief description of the purchases and the payments for the full period of trading or for a period of trading or for a period of 12 months immediately prior to the date of sequestration/liquidation, whichever is the lesser.
Furnish explanations why any item is dated after Insolvency/Judicial Management/Liquidation.
- Money lent
Annex detailed statement of account plus Acknowledgment of Debt or receipts of paid cheques.
Must be calculated to date of Provisional Order of Liquidation/Judicial Management/Sequestration. Rate of interest and periods must be shown. (No interest is claimable on open accounts unless an agreement by the debtor to pay such interest is annexed).
- Legal charges
Annex Attorney's Taxed Bill of Costs, which must show date of the items therein.
- Mortgage Bonds and HP Agreements
Annex original documents and detailed statements. Refer 1.2 above re valuation of security end 2.3 above re calculation of interest.
Annex original lease (if any) and detailed statement of rent due up to date of Provisional Order of Sequestration/Liquidation/Judicial Management showing rental and periods.
Annex original documents and detailed statement of claim against principal debtor.
3. POWER OF ATTORNEY
- Where a limited Company proves a claim, the Power of Attorney must be signed by a Director or any other person authorised by Resolution and a copy of such Resolution, as per enclosed documents must be annexed to the Power of Attorney.
Should you be unable to attend the meeting, and you are prepared to agree to a representative to be appointed by the General Body of creditors, may we suggest that the POWER OF ATTORNEY be completed with the relevant portion left blank and initialed.