In the Magistrate's Court for the District/Region of ..........................................................held at ...............................................Case No. ........................................ of 20.........

To: ............................................................................................... (Debtor)

................................................................................................... (Address)

...................................................................................................................

...................................................................................................................

Take notice that—

.............................................................................................................................................................  (name and address of Creditor) lodged a claim for the amount of R........... in respect of ............................................ (particulars of claim) as a result of which he or she allegedly became your creditor after the Administration Order was issued against you on the day of ............................20..... in the Magistrate's Court at ...................................

Kindly notify me in writing on or before the ................................ day of ........................... 20..... whether you admit or dispute this claim. Please note that if you admit the claim or no reply is received from you on or before the said date, this claim shall be deemed to be proved, subject to the right of any other creditor who has not received notice of the claim to object to the debt, and shall be added to the list of names of your creditors who share pro rata in the payments made by you in terms of the Administration Order.

Dated at ............................... this ............................. day of ............................, 20......

.................................................................

Administrator