FORM 23
BANKRUPTCY RULES
1 Bankruptcy Number 2 Name of Bankrupt/Firm
B / _________/________
(Number) ( Year)
3 Particulars of Creditor Claiming Debt
Name of Creditor :__________________________________________________________________
I/C/Passport No/Company/Business Registration No.:_____________________________________
Postal Address (see note a) ____________________________________________________________
__________________________________________________________________________________
Contact Nos. (Tel/Pager/HP) :____________________________ Fax No.: ______________________
E-mail Address:_____________________________________________________________________
Creditor’s Reference No. : ___________________________________
4 Particulars Of Claim (See note b)
Date Debt Incurred Type of Debt (See examples below )
Total Amount of Debt (In Figures)
Total Amount of Debt (In Words) :
Examples of Type of Debts:
Goods Supplied
Loan
Credit Card Facilities
Income Tax
Others (please specify )
Services Rendered
Overdraft Facilities
Hire Purchase
CPF
Currency Amount
5 Security Held (Please indicate “NIL” if no securities are being held by the creditor)
Brief Description Of Securities :__________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

6 Particulars of Person Authorised to Complete this Proof Of Debt Form
Name : _______________________________________________________________________
NRIC No./Passport No.: _________________________________________________________
Name of Firm/Company: ________________________________________________________
(eg. Solicitors/Accountants etc)
Contact Nos. (Tel/pager/HP): ____________________________ Fax No.
:_________________
E-mail Address: ________________________________________________________________
Your Reference No.
: ________________________________________
7 Signature of Creditor/Person Authorised to Complete this Proof of Debt Form
7.1
I declare that to the best of knowledge and belief, the bankrupt owes the creditor the amount claimed in box 4.
7.2
I declare that I am duly authorised by the creditor/under the seal of the creditor company (delete where applicable), to complete this proof of debt form.
Signature: _______________________________________ Date: _______/_______/________
Note: a.
Please inform the Official Assignee of any change in address. b.
Attach copies of supporting documents and detailed computation of the claim. The onus is upon the creditor to prove the debt.
WARNING: Please note that information given to the Official Assignee must be true.
Lodging a false proof of debt is an offence under Section 145 Bankruptcy Act (Cap.20) and Section 182 of the Penal Code (Cap 224).
FOR OFFICIAL USE ONLY
I admit/dispute this claim of $______________________
__________________________ ______________________
Bankrupt’s Signature Date
FOR OFFICIAL USE ONLY
Admitted at $___________________
This _____________ day of_____________year_________
________________________
Official Assignee