IN THE HIGH COURT OF
In the matter of the Companies Act, 1956

And
In the matter of Company Ltd.

AFFIDAVIT of , S/o , aged ,

presently and permanently residing in

I, the deponent abovenamed, hereby solemnly affirms and states as follows:—

1 .I say that, the abovenamed company was, on the day of
, the date of the order of the winding-up of the
same, and still is, justly and truly indebted to me for a sum of

Rs , on account of

2. I say that, I have not, nor have any person or persons by my order or to
my knowledge or belief; for my use, received the aforesaid sum of
Rs or any part thereof, or any security for satisfaction of
the same or any part thereof.

3. I say that, I attach hereto the documents marked A and B in proof of the
aforementioned debt.

Sd./ Deponent.

Verification

Verified at on this the of 20 that the
contents of the above affidavit are true and correct to the best of knowledge, belief and information of the deponent and nothing material has been concealed therefrom.

Sd./ Deponent.
Solemnly affirmed and signed before me by the deponent, who is personally
known to me, on this the day of ,20

Sd./
Counsel for the deponent.
Note: Affidavit to be attested by the appropriate authority prescribed under law.