CWR Form No. 24
Proof of Debt (standard form) (O.16, r.2)
THE COMPANIES LAW
Centaur Liquidation SPC (In liquidation)
Grand Court Cause No 53 of 2014
DOA: Official Liquidation 25 June 2015
Provisional Liquidation 27 June 2014
1
2
Creditor's Name
Creditor's Address, Telephone Number &
relevant contact email address
3
Amount of claim
Principal
Interest (if any)
Total
4
Summarise the basis upon which the claim
arises
5
List of supporting documentation (copies of
which must be attached)
6
Summarise basis for interest claim
7
Interest calculation
8
Particulars of any security held including a list
of the relevant documentation
9
Value of the security and date of valuation
_____________________________ [Signature of Creditor]
Dated: ……………………
Name (in BLOCK CAPITALS): _____________________________
Job title/authority to sign: _________________________________