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



FORM 78. Statutory Declaration As To Proof Of Debt. Employees'group Form.

FORM 78

Companies Act, 1965
Section 291


STATUTORY DECLARATION AS TO PROOF OF DEBT.
EMPLOYEES' GROUP FORM

…………………………………………. (NAMA SYARIKAT)

In the matter of the Companies Act, 1965
and
In the matter of (Nama Syarikat)
I, ................................................................. ,of ……………………………. I/C No, ................................................ in the State of …………………………. to solemnly and sincerely declare:

1. That this proof of debt is made on behalf of all the persons specified in the Schedule endorsed on this statutory declaration, being employees of the abovementioned company.

2. That the abovementioned company was, on the ……………….day of…………………... 19…………., and still is justly and truly indebted to each person whose name, address and description appears in the Schedule endorsed on this statutory declaration in respect of wages due to the person as an employee of the company for services rendered by him to the company during the periods and in the amount set out against his name in that Schedule.

That none of the persons referred to in the Schedule endorsed on this statutory declaration has to my knowledge and belief received any manner of satisfaction or security for the amount or any part of the amount due in respect of wages set out against his name in that Schedule.

And I make this solemn declaration conscientiously believing the same to be true, by virtue of the provisions of the Statutory Declarations Act, 1960.

Declared at …………………..in the State
of…………………. this …….………..day
of ……………………………,19………..

Before me-
……………………………………..

SCHEDULE

No.
Full Name
Address
Description
Period for which Wages Due
Amount Due











RM sen




...........................................
(Signature of declarant)


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