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£ s.a.

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Statement of the affairs of the above A.B. on the [here inser date of institution of proceedings].

£s. d.

a] Unsecured creditors as per Stock in trade at [state name list (A.) :

of place) estimated at

Book debts about £ Creditors fully ge

estimated to produce cured, as per list (B.)

Cash in hand Less estimated value of securities

Bills of exchange or other

similar securities, estimated Surplus to contra £

to produce

Furniture, fixtures, and fit-
£s. d.
tings at

estimated Creditors partly se

to produce cured, as per list (C.)

Property, as per list (G.). Estimated value of

Surplus from securities in securities

the hands of creditors fully Other liabilities, as per list

secured, see contra. (D.). Creditors for rent rates,

taxes, and wages, as per list (E.) . Liabilities on bills discounted, as per list (F.) £ Of which it is expected will rank against the estate for dividend Total debts. £

Total assets £

.

.

1 R

The Bankruptcy act, 1869

William Hazlitt, Great Britain

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