Bureau Trust(Gauteng)
INSOLVENCY PRACTITIONERS / INSOLVENSIE PRAKTISYNS
825 Arcadia Street, Arcadia, Pretoria / Tel: 012 343 7433 / Fax: 012 343 7545
Reg. No: 2007/210175/23
Members: / Bea Groenewald: B.Tech (HRM) (Pta): Dip. Aipsa (UP)* / VAT / BTW No: 4140242886
Lappies Labuschagne: B. Com (Regte) LLB (UP) / Income Tax no: 9077/812/16/3
Wilanda Prinsloo: Dip. Aipsa: Inter. Insol. Law Cert. (UP)*
Oscar Sithole: B.Com (Law) (UP) ; Dip Aipsa (UP)*# / PO Box 2232, Pretoria, 0001
Estates Manager: / Corné Mienie: Dip. Aipsa (UP)* / Docex 228, Pretoria
Office Manager: / Colleen Gerber / e-mail :
Fax to e-mail : 086 635 9400
Website:
* MEMBER OF “THE ASSOCIATION OF INSOLVENCY PRACTITIONERS OF SOUTHERN AFRICA”
# MEMBER OF “THE ASSOCIATION OF ADVANCEMENT OF BLACK INSOLVENCY PRACTITIONERS” / BEE Certificate: 33691
Bureau Trust is a level 4 (100%) BBBEE contributor
NOTES FOR COMPLETION OF CLAIM FORMS – insolvent estates
1affidavit
1.1Completion and Signature
(a)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 which office held by him if he holds his appointment ex officio.
(b) Alterations must be initialled by declarant and Commissioner of Oaths.
1.2Security
(a)If security is claimed, then the amount at which the creditor values such security must be inserted.
(b)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). The insertion should be initialled.
1.3Promissory Notes Etc.
Where the claim is in respect of Promissory Notes, Bills of Exchange or Cheques, the appropriate Affidavit form should be completed.
2SUPPORTING VOUCHERS
2.1Goods Supplied on Open Account
(a) Complete the statements as per attached annexed to the Affidavit (for last 12 months).
(b) Furnish explanations why any item is dated after Insolvency/Judicial Management/Liquidation.
See 2.3 below in regard to interest.
2.2Money Lent
Annex detailed statement of account plus Acknowledgement of Debt or receipts or paid cheques.
2.3Interest
(a)Interest must be calculated to date of Provisional Order of Liquidation/Judicial Management/Sequestration.
(b)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).
2.4Legal Charges
Annex Attorney's Taxed Bill of Costs which must show dates of the items therein.
2.5Mortgage Bonds and HP Agreements
Annex original documents and detailed statements. Refer 1.2 above re valuation of security and 2.3 above re calculation of interest.
2.6Rent
Annex original lease (if any) and detailed statement of rent due to date of Provisional Order of Sequestration/Liquidation/Judicial Management showing rental and periods.
2.7Suretyships
Annex original documents and detailed statement of claim against principal debtor.
3POWER OF ATTORNEY
3.1Where a limited Company/Close Corporation 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.
SIEN KEERSY VIR AFRIKAANS
/ Wilbecar Likwidateurs CC / BK t/a h/aBureau Trust(Gauteng)
INSOLVENCY PRACTITIONERS / INSOLVENSIE PRAKTISYNS
825 Arcadia Street, Arcadia, Pretoria / Tel: 012 343 7433 / Fax: 012 343 7545
Reg. No: 2007/210175/23
Members: / Bea Groenewald: B.Tech (HRM) (Pta): Dip. Aipsa (UP)* / VAT / BTW No: 4140242886
Lappies Labuschagne: B. Com (Regte) LLB (UP) / Income Tax no: 9077/812/16/3
Wilanda Prinsloo: Dip. Aipsa: Inter. Insol. Law Cert. (UP)*
Oscar Sithole: B.Com (Law) (UP) ; Dip Aipsa (UP)*# / PO Box 2232, Pretoria, 0001
Estates Manager: / Corné Mienie: Dip. Aipsa (UP)* / Docex 228, Pretoria
Office Manager: / Colleen Gerber / e-mail :
Fax to e-mail : 086 635 9400
Website:
* MEMBER OF “THE ASSOCIATION OF INSOLVENCY PRACTITIONERS OF SOUTHERN AFRICA”
# MEMBER OF “THE ASSOCIATION OF ADVANCEMENT OF BLACK INSOLVENCY PRACTITIONERS” / BEE Certificate: 33691
Bureau Trust is a level 4 (100%) BBBEE contributor
aANTEKENINGE BY DIE VOLTOOIING VAN EISDOKUMENTE
1BEëDIGDE VERKLARING
1.1Voltooiing en Ondertekening
(a)Die Kommissaris van Ede moet sy volle naam en besigheidsadres in drukletters onder sy handtekening aanbring en sy ampstitel en die gebied waarvoor hy aangestel is of sy amp, indien hy ampshalwe aangestel is, meld.
(b) Veranderinge moet deur die Deklarant en die Kommissaris van Ede geparafeer word.
1.2Sekuriteit
(a)Indien sekuriteit geëis word, moet die skuldeiser die bedrag waarteen hy sy sekuriteit waardeer, invul.
(b)'n Versekerde skuldeiser wat hom uitsluitend verlaat op sy sekuriteit moet daardie feit te kenne gee op die Beëdigde Verklaring bo die handtekening van die Deklarant. (Sien 2.5 hieronder). Hierdie invoeging moet geparafeer word.
1.3Promesse, ens.
Indien die eis ten opsigte van Promesses, Wissels of Tjeks is, moet 'n aparte Beëdigde Verklaring voltooi word.
2STAWENDE BEWYSSTUKKE
2.1Goedere op ope rekening gelewer
(a)Voltooi die staat wat aan die Beëdigde Verklaring geheg is. Die Staat moet 'n kort beskrywing van die aankope, die maandelikse totaal daarvan en alle betalings ontvang of krediete toegestaan, vir die volle tydperk van handeldrywe of vir 'n tydperk van 12 maande onmiddellik voor datum van die Sekwestrasie/Likwidasie, welke ookal die kortste is, aandui.
(b)Verwys na 2.3 hieronder in verband met rente.
2.2Geld Geleen
Heg 'n gespesifiseerde rekening plus Erkenning van Skuld of kwitansies of betaalde tjeks aan.
2.3Rente
(a)Moet tot by die datum van Voorlopige Sekwestrasie-, Likwidasie- of Geregtelike Bestuursbevel bereken word.
(b)Rentekoers en tydperk moet getoon word. (Geen rente mag gevorder word op ope rekenings nie, tensy 'n ooreenkoms deur die skuldenaar om sodanige rente te betaal, aangeheg is).
2.4Regskoste
Die Prokureur se getakseerde rekening wat die datums van die items daarin toon, moet aangeheg word.
2.5Verbande en Huurkoopooreenkomste
Heg die oorspronklike dokumente en gespesifiseerde staat aan. Verwys na 1.2 hierbo ten opsigte van die waardasie van sekuriteit en 2.3 hierbo ten opsigte van berekening van rente.
2.6Huurgeld
Heg die oorspronklike huurkontrak aan (indien enige) en 'n gespesifiseerde staat wat die huur verskuldig tot op datum van Voorlopige Sekwestrasie-, Likwidasie- of Geregtelike Bestuursbevel, die maandelikse huurgeld en die tydperk aantoon.
2.7Borgskappe
Heg die oorspronklike dokumente en 'n gespesifiseerde Staat van die eis teen die hoofskuldenaar aan.
3PROKURASIE
3.1Indien 'n Maatskappy/Beslote Korporasie 'n eis bewys, moet die Prokurasie geteken word deur 'n Direkteur of enige ander persoon wat deur 'n Spesiale Besluit daartoe gemagtig is. 'n Afskrif van sodanige Besluit moet aan die PROKURASIE geheg word.
SEE REVERSE FOR ENGLISH
/ Wilbecar Likwidateurs CC / BK t/a h/aBureau Trust(Gauteng)
INSOLVENCY PRACTITIONERS / INSOLVENSIE PRAKTISYNS
825 Arcadia Street, Arcadia, Pretoria / Tel: 012 343 7433 / Fax: 012 343 7545
Reg. No: 2007/210175/23
Members: / Bea Groenewald: B.Tech (HRM) (Pta): Dip. Aipsa (UP)* / VAT / BTW No: 4140242886
Lappies Labuschagne: B. Com (Regte) LLB (UP) / Income Tax no: 9077/812/16/3
Wilanda Prinsloo: Dip. Aipsa: Inter. Insol. Law Cert. (UP)*
Oscar Sithole: B.Com (Law) (UP) ; Dip Aipsa (UP)*# / PO Box 2232, Pretoria, 0001
Estates Manager: / Corné Mienie: Dip. Aipsa (UP)* / Docex 228, Pretoria
Office Manager: / Colleen Gerber / e-mail :
Fax to e-mail : 086 635 9400
Website:
* MEMBER OF “THE ASSOCIATION OF INSOLVENCY PRACTITIONERS OF SOUTHERN AFRICA”
# MEMBER OF “THE ASSOCIATION OF ADVANCEMENT OF BLACK INSOLVENCY PRACTITIONERS” / BEE Certificate: 33691
Bureau Trust is a level 4 (100%) BBBEE contributor
BEëDIGDE VERKLARING tot bewys van 'n ander vordering as 'n vordering op grond van 'n Promesse of ander Wissel. [Art. 44(4)].
AFFIDAVIT for the proof of any claim other than a claim based on Promissory Note or other Bill of Exchange [Section 44(4)].
IN DIE INSOLVENTE BOEDEL VAN
IN THE INSOLVENT ESTATE OF
VOLLE NAAM VAN SKULDEISER
FULL NAME OF CREDITOR
(hereinafter referred to as the said Creditor) / (hierna verwys word as die genoemde Skuldeiser)
VOLLEDIGE FISIESE ADRES
PHYSICAL ADDRESS IN FULL / POSKODE
POSTAL CODE
VOLLEDIGE POSADRES
FULL POSTAL ADDRESS / POSKODE
POSTAL CODE
TELEFOONNOMMER
TELEPHONE NUMBER / FAKSNOMMER
FAX NUMBER
TOTALE BEDRAG VAN VORDERING
TOTAL AMOUNT OF CLAIM
R
I (1)
Ek, (1) / do hereby make an oath and say:
verklaar onder eed as volg:
1. That I am (2)
Dat ek die (2) / of (3)
is van (3)
(hereinafter referred to as the said Creditor) / (hierna verwys word as die genoemde Skuldeiser)
2. / That I have personal knowledge of the facts hereinafter stated. Dat ek persoonlik kennis dra van die feite hierin uiteengesit.
3. / That (4)
Dat (4)
(hereinafter referred to as the said Insolvent) / (hierna verwys word as die genoemde Insolvent)
whose estate has been sequestrated, was at the date of sequestration and still is indebted to the said Creditor
van wie die boedel gesekwestreer is, op die dag van sekwestrasie en nou nog steeds verskuldig is aan die genoemde Skuldeiser
the sum of (words)
die som van (woorde)
for (5)
vir (5)
4. / That the said debt arose in the manner and at the time set forth in the account annexed hereto.
Dat voormelde skuld ontstaan het op die wyse en op die datum soos op die hierby aangehegte rekening uiteengesit.
5. / That no other person besides the Insolvent is liable (otherwise than as surety) for the said debt or any part thereof.
Dat geen ander persoon buiten die Insolvent vir die voormelde skuld of enige deel daarvan aanspreeklik is nie (behalwe as borg)
6. / That the Creditor has not, nor any other person to my knowledge on the Creditor's behalf received any security for that said debt or any part thereof save and except (6)
Dat nóg die genoemde Skuldeiser, nóg volgens my wete enige ander persoon, namens die genoemde Skuldeiser enige sekuriteit vir die genoemde skuld of enige deel daarvan ontvang het nie, behalwe (6)
which security I value at
welke sekuriteit ek waardeer teen / R
7. / That this claim was not acquired by cession after the institution of the proceedings by which the estate was sequestrated.
Dat die vordering nie verkry is deur sessie na die instelling van die proses vir sekwestrasie van die boedel nie.
Handtekening van Deponent (7)
Signature of Deponent (7)
Ek sertifiseer hiermee dat die deponent verklaar het dat hy/sy die inhoud van hierdie verklaring verstaan en begryp en dat dit die waarheid is na die beste van sy/haar kennis en wete, welke
I hereby certify that the Deponent has acknowledged that he/she knows and understands the contents of this affidavit which
verklaring voor my geteken en beëdig is te
was signed and sworn before me at / op hierdie
on the / dag van
day of / 20
20
en dat daar voldoen is aan die bepalings vervat In Goewermentskennisgewing Nr. R1258 van 21 Julie 1972, soos gewysig, en Goewermentskennisgewing Nr. R1648 van 19 Augustus
1977, soos gewysig. / and that the the regulations contained in Government Gazette Notice No R1258 of 21 July 1972, as amended, and Government Gazette Notice No R1648 of
19 August 1977, as amended, having been complied with.
NOTAS:
- Volle Naam.
- Dui hier die verwantskap met die krediteur aan bv. Bestuurder, Direkteur, ens. of skrap indien deponent die krediteur is.
- Volle naam van krediteur.
- Naam van Insolvente boedel.
- Soort transaksie bv. Goedere verkoop en gelewer.
- Meld hier aard, of besonderhede en waarde van verbande ander sekuriteit (indien enige)
- 'n Persoon wat optree namens 'n Maatskappy / Beslote Korporasie moet die verklaring persoonlik
- Full name.
- Here state the relation of the deponent to the creditor, as Manager, Director, etc., or strike out if the deponent is the creditor.
- Full name of creditor.
- Name of Company/Close Corporation in liquidation/insolvent.
- Type of transaction e.g. goods sold and delivered.
- Here insert nature, particulars and value of mortgage, pledge or other security (if any).
COMMISSIONER OF OATHS / KOMMISSARIS VAN EDE
Volle naam en adres van kommissaris /
Ful name and address of Commissioner
______
______
______
VERKLARING VIR DIE BEWYS VAN ‘N EIS GEBASEER OP ‘N PROMESSE OF ANDER WISSEL
AFFIDAVIT FOR THE PROOF OF A CLAIM BASED ON A PROMISSORY NOTE OR OTHER BILL OF EXCHANGE
Insolvente Boedel van
Insolvent Estate of
Volledige Naam van Krediteur
Full Name of Creditor
Fisiese Adres / Physical Adress
Posadres / Postal Address
Totale Bedrag van vordering
Total Amount of Claim / R
Ek
I / in my hoedanigheid as
in my capacity as / en as sulks ten volle op hoogte vandie feite hieronder vervat, verklaar onder eed:
and as such cognizant with the facts contained herein, declare under oath:
dat / that / wie se boedel gesekwestreer is, was op die dag van sekwestrasie, en is nog steeds
whose estate has been sequestrated, was at the date of sequestration and still is,
verskuldig aan
indebted to / die bedrag van (woorde)
in the sum of (words)
vir
for / kragtens die volgende Promesse of Wissel(s)
by virtue of the following Promissory Note(s) or Bill(s) of exchange
Datum van Promesse of bewys
Date of Note or Bill / Naam van Ondertekenaar of Trekker
Name of Maker or Drawer / Naam van Akseptant
Name of Acceptor / Naam van Persoon aan wie betaalbaar
Name of Person to whom payable / Datum betaalbaar
Date when payable / Naam van Endossant
Name of Endorser / Bedrag
Amount
That the said debt arose in the manner and at the time set forth in the account hereunto annexed and that the claim was not acquired by cession after the institution of the proceedings whereby the Estate was placed under sequestration. That the said Promissory Note or Bill(s) of Exchange is in all respects genuine and valid.
Dat genoemde skuld ontstaan het op die wyse en op die datums soos op die hierby aangehegte rekening uiteengesit en dat die vordering nie verkry is deur sessie na die instelling van die proses vir die
sekwestrasie van die Boedel. Dat die genoemde Promesse of Wissel(s) in alle opsigte eg en geldig is.
That besides the said Insolvent Estate, the Endorser(s) abovementioned namely
Dat behalwe die genoemde Insolvente boedel, die Endossant(e) bovermeld naamlik
is liable for the amount of the Bill(s) or Note(s) as:
verantwoordelik is vir bedrag van die Promesse of Wissel(s) as:
That I have not, nor has any other person to my knowledge, for the use of the above Creditor, received any Security for the debt or any part thereof,
Dat nog ek, nog volgens my wete enige ander persoon, vir die gebruik van bogenoemde Skuldeiser, enige sekuriteit vir die genoemde skuld of enige deel daarvan ontvang het nie,
save and except
buiten en behalwe / which security I value at
welke sekuriteit ek waardeer teen / R
Signature of Declarant
Handtekening van Deklarant
Ek sertifiseer hiermee dat die Deponent verklaar dat hy/sy die inhoud van hierdie verklaring verstaan en begryp en dat dit die waarheid is na die beste van sy/haar kennis en wete, welke verklaring voor my
I hereby certify that the Deponent has acknowledged that he/she knows and understands the contents of this affidavit, which was
geteken en beëdig iste
signed and sworn before me at / op hierdie
on this / dag van
day of / 20 / en dat daar voldoen is aan die
and that the the Regulations
bepalings vervat in Goerwermentskennisgewing Nr R1258 van 21 Julie 1972, soos gewysig en Goewermentskennisgewing Nr R1648 van 19 Augustus 1977, soos gewysig.
contained in Government Notice No R1258 of 21 July 1972, as amended, and Government and Government Notice No R1648 of 19 August 1977, as amended, having been complied with.
KOMMISSARIS VAN EDE / COMMISSIONER OF OATHS
(PTY) LIMITED / CLOSE CORPORATION
CERTIFIED EXTRACT FROM THE MINUTES OF A MEETING OF DIRECTORS/MEMBERS OF THE ABOVEMENTIONED COMPANY/CLOSE CORPORATION
HELD AT
ON THE / DAY OF / 20
IT WAS RESOLVED:
That Mr.
A director/secretary/accountant/ member
of the Company be and he is hereby authorized and empowered, for and on behalf of and in the name of the Company:-
(a) to institute and conduct proceedings including proceedings for liquidation and sequestration in any competent Court in the Republic of South Africa, the territory of Namibia, Zimbabwe, Zambia, Malawi,Lesotho, Botswana, Mozambique, Angola and Swaziland against the Company's debtors for recovery ofamounts due and owing.
(b) to lodge, file and prove claims against deceased or insolvent estates or against companies in liquidationand under judicial management, to vote for the appointment and election of trustees, liquidators andjudicial managers, to attend meeting and to vote on all matters arising from such claims.
(c) for these purposes to instruct, brief and employ attorneys, solicitors and Council to represent and appearfor and act on behalf of the Company.
(d) to sign all Powers of Attorney, affidavits and other documents and writings which may be necessary forthe carrying out of the above purposes.
CERTIFIED A TRUE COPY
AUTHORISED OFFICIAL
Name and Address of Creditor:
Naam van Skuldeiser:
Name of Insolvent Estate:
Naam van Insolvente Boedel:
Brief Description of goods Supplied:
Kort beskrywing van goedere:
DETAILS OF SALES (for last 12 months)
Besonderhede van verkope (laaste 12 maande)
DateDatum / Invoice No.
Faktuur Nr. / Amount
Bedrag / Monthly Totals
Maandelikse Totaal
TOTAL DEBITS "A”
TOTALE DEBIETE “A” R
DETAILS OF PAYMENTS RECEIVED AND CREDITS ALLOWED (for last 12 months)
BESONDERHEDE VAN BETALINGS ONTVANG EN KREDIETE TOEGESTAAN (for last 12 months)
DateDatum / Payments and/or Credits (specify)
Betalings en/of krediete (spesifiseer) / Amount
Bedrag / Monthly Totals
Maandelikse Totaal
TOTAL DEBITS "B”
TOTALE DEBIETE “B” R
AMOUNT OF CLAIM
BEDRAG VAN EIS:
AMOUNT OF CLAIM AS PER AFFIDAVIT (Total "A" less "B" )BEDRAG VAN EIS SOOS PER VERKLARING (Totaal “A” minus “B’) R
PROKURASIE VIR DIE BEWYS VAN EISE ENS.
POWER OF ATTORNEY TO PROVE CLAIMS ETC.
Ek, die ondergetekende
I, the undersigned
in my hoedanigheid as
in my capacity as
van
of
(Hierna verwys as die genoemde Skuldeiser) benoem, konstitueer en stel hierby aan
(Hierinafter referred to as the said Creditor) do hereby nominate constitute and appoint
met Mag van Substitusie om die genoemde Skuldeiser se wettige Prokureur en Agent te wees, en in die genoemdeSkuldeiser se naam en namens die genoemde Skuldeiser alle vergaderings van Skuldeisers by te woon, in die saak van:
with power of substitution to be the said Creditor's lawful Attorney and Agent in the said Creditor's name, place andstead, to attend all meetings of Creditors in the matter of:
en namens die genoemde Skuldeiser, die genoemde Skuldeiser se eis te bewys, en om namens die genoemde Skuldeiserte stem en om alle magte uit te oefen ten opsigte van sodanige eis met betrekking tot die aanstelling van Trustee/LikwidateurGeregtelikeBestuurder en/of enige aanbod van Komposisie en/of voorlegging tot arbitrasie van enige dispuut en/of dieKomposisie en/of voorlegging tot arbitrasie van enige dispuut en/of die Komposisie of toelating van enige eis teen die Boedel/ Maatskappy en om aan die Trustee's/Likwidateurs/Geregtelike Bestuurder's opdragte te gee, in verband met die administrasievan die boedel/maatskappy en om in die algemeen op te tree namens die genoemde Skuldeiser op alle vergaderings van dieBoedel/Maatskappy in alle sake waarin die genoemde Skuldeiser belange hê, en belowe hiermee om goed te keur en tebekragtig wat ook al die genoemde Agent mag doen of te weeg bring uit krag hiervan.