FORM 61. Statement Of Affairs. (COMPANIES REGULATIONS, 1966

P.U. 173/66
COMPANIES REGULATIONS, 1966
SECOND SCHEDULE (Regulation 3)

FORM 61. Statement Of Affairs.

FORM 61

Companies Act, 1965
Sections 188 and 189, 234 and 260 (4)

STATEMENT OF AFFAIRS

………………………………………(NAMA SYARIKAT)

Statement of Assets and Liabilities as at the………day of………………. . ,19 ………. .

	Cost or Book Value*	Estimated Realizable Values
1. ASSETS NOT SPECIFICALLY CHARGED (a) Real estate as detailed in Schedule At . . . . . . (b) Sundry debtors as detailed in Schedule B + . . . (c) Cash on hand . . . . . . . . . . . . . . . (d) Cash at bank . . . . . . . . . . . . . . . (e) Stock as detailed in inventory . . . . . . . . . (f) Plant and equipment as detailed in inventory . . . (g) Other assets as detailed in Schedule C + . . . 2. ASSETS SUBJECT TO SPECIFIC CHARGES, RM sen LINES, MORTGAGES. BILLS OF SALE OR HIRE-PURCHASE AGREEMENTS, as detailed in Schedule D + . . . . . . . . . . . . . . . Less amounts-owing. as detailed in Schedule D TOTAL ASSETS . . . . . . . . . . . . . . . 3. Less PREFERENTIAL CREDITORS ENTITLED TO PRIORITY OVER THE HOLDERS OF DEBENTURES UNDER ANY FLOATING CHARGE, as detailed in Schedule E . . . . . . . . . . . . . . . 4. Less AMOUNTS OWING AND SECURED BY DEBENTURE OR FLOATING CHARGE OVER COMPANY's ASSETS TO . . . . . . 5. Less PREFERENTIAL CREDITORS as detailed in Schedule F. . . . . . ESTIMATED AMOUNT AVAILABLE FOR UNSECURED CREDITORS . . . 6. CREDITORS (UNSECURED) as detailed in Schedule G Amount claimed (RM ) . . . . . . . . . . . . . . . 7. BALANCES OWING TO PARTLY SECURED CREDITORS as detailed in Schedule H Total claims (RM ) Security held (RM )	RM sen	RM sen
8. CONTINGENT ASSETS RM . . . . . . . . . . . . . . . . . . . . . Estimated to produce RM As detailed in Schedule I . . . . . . . . . . . . . . . . . . 9. CONTINGENT LIABILITIES RM . . . . . . . . . . . . Estimated to rank for RM As detailed in Schedule J . . . . . . . . . . . . . . . . . . . . . ESTIMATED* DEFICIENCY/* SURPLUS (Subject to costs of administration liquidation)	RM sen

SHARE CAPITAL
Issued (RM sen)
Paid up (RM sen)

SCHEDULE A
REAL ESTATE

Address and Description of Property	Cost Price or Book Value	Estimated Realizable Value	Valuation for Rating Purposes	Particulars of Tenancy	Where Possession of Deeds may be Obtained	Short Particulars of Title
	RM sen	RM sen	RM sen

SCHEDULE B
SUNDRY DEBTORS (INCLUDING LOAN DEBTORS)

Name and Address of Debtor	Amount Owing	Amount Realizable	Deficiency	Particulars of Security (if any) Held	Explanation of Deficiency
	RM sen	RM sen	RM sen

SCHEDULE C
OTHER ASSETS

Description of Deposit or Investment	Cost	Amount Realizable
Deposits Investments -	RM sen	RM sen

SCHEDULE D
ASSETS SUBJECT TO SPECIFIC CHARGES, LIENS, MORTGAGES, BILLS OF SALE OR HIRE PURCHASE AGREEMENTS

Description of Asset	Date Charge Given	Description of Charge	Holder of Charge	Terms of Repayment	Cost or Book Value	Estimated Realizable Value	Amount Owing under Charge
					RM sen	RM sen	RM sen

SCHEDULE E
PREFERENCE AL CREDITORS ENTITLED TO PRIORITY Over THE HOLDERS OF DEBENTURES UNDER ANY FLOATING CHARGE

Employee's Name and Address	Wages	Holiday Pay	Long Service Leave	Estimated Liability
	RM sen	RM sen	RM sen	RM sen

SCHEDULE F
PREFERENTIAL CREDITORS (OTHER THAN THOSE DETAILED IN SCHEDULE)

Name and Address of Preferential Creditor	Description of Amount Owing	Amount Owing
		RM sen

SCHEDULE G
UNSECURED CREDITORS

Name and Address of Creditor	Amount Claimed by Creditor	Amount Admitted as Owing	Reason for Disputed Amount (if any)
	RM sen	RM sen

SCHEDULE H
PARTLY SECURED CREDITORS

Name and Address of Creditor	Particulars of Security Held	Nature of Security	Estimated Value of Security Held	Amount Owing to Creditor	Amount Estimated to Rank as Unsecured
			RM sen	RM sen	RM sen

SCHEDULE I
CONTINGENT ASSETS

Description of Asset	Gross Asset	Estimated to Produce
	RM sen	RM sen

SCHEDULE J
CONTINGENT LIABILITIES

Name and Address of Creditor	Nature of Liability	Gross Liability	Estimated to Rank for
		RM sen	RM sen

I hereby certify that the particulars contained in the above statement of affairs are true to the best of my knowledge and belief

Dated this……………day of…………. . ,19 ………

(Signature) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

__________________________________________________
*Indicate in respect of each entry whether cost or book value.

† Where this statement of affairs is made for the purposes of subsection (4) of section 260 of the Companies Act, 1965. Schedules A. B, C and D are to show the method and manner in which the valuation of the assets were arrived at.

‡ Strike out whichever is inapplicable.

NOTES

This statement of affairs is to be made as at the following dates:

(a)

Where submitted to a receiver or manager under sections 188 and 189 of the Companies Act, 1965, the date of the receiver's or manager's appointment;

(b)

Where submitted to a liquidator under section 234 of that Act, the date of the winding up order.

This statement of affairs is to be submitted by, and is to be verified by an affidavit in accordance with Form 62 sworn by the following persons:

(a)

Where the statement is made out for the purposes of section

188

of the Companies Act,

1965,

a person referred to in section

189 (2) of

that Act;

(b)

Where the statement is made out for the purposes of section

234 of

the Companies Act,

1965,

a person referred to in section

234 (2) of

that Act.

Regulation 13 of the Companies Regulations requires the copy of this statement of affairs that is lodged with the Registrar of Companies to be certified in writing to be a true copy of the original statement -

(a)

in the case of a copy lodged for the purposes

section

188 (1) (c) (i)

of the Companies Act, 1965, by the receiver or manager

the property of the company;

(b)

in the case of a copy lodged for the purposes of section

234 (3) of

that Act, by the liquidator of the company.