382
THE NEW ZEALAND GAZETTE.
[No. 21

Form No. 5.
ORDER APPOINTING ASSIGNEE RECEIVER AND MANAGER
OF DEBTOR’S PROPERTY. (Rules 92-95.)

[Title.]
Upon reading the notice of motion herein, and upon hearing
, it is ordered that [upon a deposit of £
being
lodged by the said
], Esq., the Official Assignee,
be thereupon constituted interim receiver and manager of the
property of the said A.B., and [Here insert directions, if any].
Dated this
day of
, 189
.
By the Court.
Registrar.

Form No. 6. (Rule 25.)
WARRANT AGAINST DEBTOR UNDER SECTION 88 OF
THE ACT.

[Title.]
To
Officer of this Court, and to the Keeper of
the [Here insert the prison].
WHEREAS by evidence taken upon oath it hath been made
to appear to the satisfaction of the Court that there is pro-
bable reason to suspect and believe that the said A.B., of
, is about to go abroad [or quit his place of residence]
with a view of avoiding service of a bankruptcy petition [or of
avoiding appearing to a bankruptcy petition, or of avoiding
examination in respect of his affairs, or otherwise defeating,
delaying, or embarrassing the proceedings in bankruptcy,
or of avoiding payment of a judgment debt in respect of
which a bankruptcy notice has been issued]:
[Or that there is probable cause to suspect and believe
that the said A.B. is about to remove his goods or chattels
with a view of preventing or delaying such goods or chattels
being taken possession of for the purposes of “The Bank-
ruptcy Act, 1892,” or that the said A.B. has concealed, or
is about to conceal or destroy, his goods or chattels, or some
of them, or his books, documents, or writings, or some or
one of them]:
These are therefore to require you, the said
, to take
the said A.B. and to deliver him to the said Keeper of the
above-named prison, and you, the said
, to receive the
said A.B., and him safely to keep in the said prison until
such time as the Court may order.
Dated this
day of
, 189
.
By the Court.
Registrar.

Form No. 7.
ORDER OF ADJUDICATION. (Section 41 of the Act.)

[Title.]
Upon reading the petition of
, dated
, 189
,
against [Here insert name, description, and address of debtor],
and upon reading
, and upon hearing Mr.
of counsel for the said petitioner, it is ordered that the said
[debtor] be, and the said
is, hereby adjudged bankrupt.
Dated this
day of
, 189
.
By the Court.
Registrar.

Form No. 8.
STATEMENT OF BANKRUPT’S AFFAIRS. (Section 60 of the Act.)

[Title.]
I, A.B., the above-mentioned bankrupt, do solemnly and
sincerely declare—

1. That the statement hereunto annexed and marked
   A contains, with the lists attached thereto marked B,
   C, D, and E, respectively, a true statement showing
   the particulars of my assets and liabilities, the names,
   residences, and occupations of my creditors, and the securities
   held by them respectively.
   And I make this solemn declaration conscientiously
   believing the same to be true, and by virtue of the provisions
   of an Act of the General Assembly of New Zealand intituled
   “The Justices of the Peace Act, 1882.”
   Declared at
   , this
   day of
   , 189
   ,
   before me—
   C.D.,
   A Justice of the Peace [or solicitor of
   the Supreme Court of New Zealand,
   or notary public].

A.—STATEMENT OF BANKRUPT.

Dr.
£ s. d.
Unsecured creditors, as per List B
..
..
..
Secured creditors, as per List C
..
..
..
Less estimated value of
securities ..
..
Surplus to contra £
Other liabilities, as per List D
Total debts ..
£

Cr.
£ s. d.
Stock-in-trade at [State name of
place] estimated at
..
..
..
Book debts, £
esti-
mated to produce
..
..
Cash in hand
..
Furniture ..
..
Property, as per List E
Surplus from securities in hands
of secured creditors
..
Total assets ..
£

Deficiency, £

B.
LIST OF UNSECURED CREDITORS.

No.
Name.
Address.
Occupation.
Amount of Debt.
£ s. d.
1
.
2
3
4
5
6
Total .. £

C.
LIST OF SECURED CREDITORS.

No.
Name of Creditor.
Address.
Occupation.
Estimated Value of Security.
Amount of Debt.
£ s. d.
£ s. d.
1
A.B. ..
Wellington
Merchant..
[Here state particulars of security.]
2
C.D. ..
Christchurch
Merchant..
[Here state particulars as above.]
Total estimated value of securities £
Total amount of debts of creditors hold-
ing securities. ..
..
£

D.
Liabilities.
Amount.
£ s. d.
[Here specify any liabilities not already
scheduled.]
Total ..
..
..
£