ANNEX 1

Re: [name of company/bankrupt] Court No:

To:

Would you please complete this questionnaire and return it with copies of the documents requested as soon as possible to the Official Receiver.

1. Where different from above please state your business’s full:

Name:

Address:

Reference/Contact::

Please also state your business’ telephone number:

2. Please state in general terms the nature of the goods which are the subject of your claim:

3. Please state the total amount which you consider is owed to you by the [company now in liquidation/bankrupt] and the period to which the debt relates:

4. Please supply either:

(a) a copy of the inventory prepared by you at the [company’s/bankrupt’s] premises and state the location of the goods which you are claiming; or

(b) a list of the goods that you are claiming which you believe are on the [company’s/bankrupt’s] premises.

5. In respect of all goods over which you make a claim please supply copies

of:

(a) the order(s);

(b) the acknowledgement of order;

(c) the delivery note(s); and

(d) the invoice(s).

6. Please provide proof that you can identify the goods over which you make a claim as relating to unpaid as opposed to paid invoices.

7. In relation to your terms of business:

(a) please supply a copy;

(b) indicate on which item(s) of stationery your terms are to be found (eg.

price list, acknowledgement of order, delivery note, invoice)

(c) confirm when your current terms of business were introduced;

(d) state where, when and how your terms of business were supplied to the [company now in liquidation/bankrupt];

(e) provide evidence of acceptance of your terms by the [company now in liquidation/bankrupt].

8. Was a copy of the [company’s/bankrupt’s] terms of business brought to your attention and if so how and when was this done:

9. Where the order(s) was/were not made in writing please give details of how the order(s) was/were placed, by whom it was placed and to whom in your business they spoke. Please state the date(s) upon which the order(s) was/were placed and the date(s) for delivery of those goods:

10. Who was responsible for insuring the goods?

11. Please provide:

(a) a copy of your sales ledger account detailing your trading with the [company now in liquidation/bankrupt] during the last twelve months, or

(b) if this information is not contained within the sales ledger, details of all payments (if any) received from the [company now in liquidation/bankrupt] in respect of the goods over which you make a claim.

Please return this questionnaire to:

The Official Receiver Reference: