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 senRM senRM sen

SCHEDULE C
OTHER ASSETS
Description of Deposit or Investment
Cost
Amount
Realizable
    Deposits










    Investments -
RM senRM 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 senRM 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 senRM sen


SCHEDULE J
CONTINGENT LIABILITIES
Name and Address of
Creditor
Nature of Liability
Gross
Liability
Estimated to
Rank for
RM senRM 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:


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:


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 -



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