Statistics Act, 1999
R 385
Insolvency Act, 1936 (Act No. 24 of 1936)SchedulesFirst Schedule : FormsForm 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. |
