Special administration—Creditor’s statement of claim

The following Restructuring & Insolvency precedent provides comprehensive and up to date legal information covering:

  • Special administration—Creditor’s statement of claim

Special administration—Creditor’s statement of claim

[company name]

Date of special administration [date]

Creditor’s name and address [name, address and registered number]

Gross amount due to creditor at date of administration order [inclusive of VAT]:£
If the total amount above includes outstanding uncapitalised interest please state amount:
Deduct:
(a) any subsequent payment on account
(b) any subsequent credit notes
(c) the estimated value of any security held
(d) the estimated value of any retention of title rights
Amount of claim for voting purposes:

Please give particulars of how and when the debt was incurred:

Please give particulars of any security held, the value of the security, and the date it was given:

Please give particulars of any retention of title claim:

Signature [signature]

Position in company [position]

Date [date]

Notes:

  1. Supporting documents must be attached unless copies have previously been forwarded

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