AFFIDAVIT OF CREDITOR OF HIS DEBT DURING LIQUIDATION

IN THE (HIGH) COURT OF __________________

IN the matter of the Indian Companies Act, 1956

And

The matter of the liquidation of ________ Co. Ltd.

I, AA , aged _________ years, son of _______ , resident of _________ , do hereby on oath /on solemn affirmation
state as follows:

1. That the above-named company was on the ________ day of ________ , 15 ______ , the date of the order for
winding up the same, and still is justly and truly indebted to me in the sum of Rupees ________ (Rs in words )
only on account of (describe briefly the nature of the debt). 2. That in proof of the aforesaid debt I attach hereto
the documents marked X, Y and Z. 3. That I have not, nor have any person or persons by my order or to my
knowledge or belief for my use, received the aforesaid sum of Rupees ________ or any part thereof, or any
security or satisfaction for the same or any part thereof except the sum or security (state the exact amount of
security).

4. That this affidavit is true, that it conceals nothing and no part of it is false

AA

Signature
VERIFICATION

I, ________the above named deponent do hereby verify on oath that the contents of the affidavit above are true
to my personal knowledge and nothing material has been concealed or falsely stated. Verified at ______ this
_____day of ______

DEPONENT