Proof of Debt Application

I  claim that the above company was indebted to the creditor.

If this claim is being made on behalf of the creditor, please specify your relationship to the creditor:

for the sum of (amount in words)   $

Either: 
I am an unsecured creditor  OR
I am surrendering my security and I am claiming as an unsecured creditor OR
I am making a preferential claim (refer details below)  OR
I am claiming reservation of the title rights (refer details below)

Date	Details of claim and Identification of Documents that Evidence or Substantiate the Claim	Amount * Include GST info below $

Attach Relevant Files:

File 1 :
File 2 :
File 3 :
File 4 :
File 5 :

Preferential Claimants Only
1. Are you claiming the full amount of your claim as preferential?	Yes     No
2. If no, what part of the claim is preferential?
3. Why do you believe you are a preferential creditor? ( e.g employee, GST, PAYE, etc )
4. Details of your claim
* If applicable, please record your GST registration number here
Total GST included in your claim