Fillable STATEMENT OF AFFAIRS In Liquidation Companies Act 1993 (Ministry of Business, Innovation and Employment New Zealand)

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STATEMENT OF AFFAIRS In Liquidation Companies Act 1993 (Ministry of Business, Innovation and Employment New Zealand)

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Physical Address Postal Address (if different)
STATEMENT OF AFFAIRS
In Liquidation Companies Act 1993
Company
Name
Trading Name
Has the company carried on business / traded in any other name?
Yes
No
Give details
PART A – CONTACT INFORMATION
1. NAME OF PERSON COMPLETING THIS FORM
Address
Telephone
Home
Work
Fax
Mobile Email
Capacity in the Company
Director Shareholder
Manager Employee
Accountant Solicitor
Other
(Please give details)
2. COMPANY CONTACT DETAILS
Telephone
Mobile Fax
Email
1
Physical Address Postal Address (if different)
Physical Address Postal Address (if different)
3. DIRECTORS CONTACT DETAILS
Director 1
Name
Telephone
Home
Work
Fax
Mobile
Email
Director 2
Name
Telephone
Home
Work
Fax
Mobile
Email
4. COMPANY ACCOUNTANT (IF ANY)
Firm Name
Address
Contact Person(s)
Phone
Previous Accountant
Firm Name
Address
Contact Person(s)
Phone
Date ceased acting
5. COMPANY SOLICITOR (IF ANY)
Firm Name
Address
Contact Person(s)
Phone
Previous Solicitor
Firm Name
Address
Contact Person(s)
Phone
Date ceased acting
2
Name Address
Phone
Name of Provider Nature of Service Postal Address (if different)
Yes No
Name of Receiver and
contact details
Appointed by
Date appointed
Date ceased
PART B
–
BACKGROUND
6.
Nature of company’s business (give details)
Date started trading Date ceased trading
7a.
Does / did the company rent / lease business premises?
Yes
No
b.
Name of landlord / agent of business premises
What was the amount paid?
c.
What date is the rent paid up
to?
d.
Is there a lease agreement?
Yes No
What is the term of the lease?
e.
Who has the company’s copy of the lease agreement?
f.
Are there any subleases?
Yes
No
Give details
g.
Have any leases been assigned, surrendered or otherwise disposed of by the company before the date
Yes
No
Give details
h.
Are the premises protected by a
security alarm?
Yes
No
Give details
i.
Who holds keys to the premises?
8.
Are there ongoing contracts for which the company is receiving a service eg. security monitoring of premises?
Yes
No
Give details
9.
Has the company ever been, or is it currently in receivership?
3
Name of Purchaser Item Sold Date of Sale Sale Price Details of Payment
10a
.
Is there a debenture over the assets of the company?
Debenture
Yes
No
holder
b.
Have steps been taken to realise security?
Yes No
Give details
11.
Has any person(s) involved in the management of this company been involved in another company that has been liquidated
or placed in receivership?
Yes
No
Give details
12.
Has any person(s) involved in the management of this company ever been made bankrupt?
Yes
No
Give details
13.
Has any person involved in this company personally guaranteed any of the company’s debts?
Yes
No
Give details
14.
When do you believe the company first became unable to pay its debts as they fell due and what made you choose this date?
15.
Were creditors informed of the company’s position?
Yes
No
Give details
16.
Has any of the company’s property been seized in the last 6 months, eg by distress warrant or distraint?
Yes No
Give details
17.
Has the company given away any of its property in the last two years?
Yes
No
Give details
18.
Has any person or other entity left any property or belongings in the company’s care?
Yes
No
Give details
19.
Does any person or other entity have any of the company’s property?
Yes
No
Give details
20.
Has the company sold any property to a director, shareholder, a relative of a director or shareholder or any entity (ie company or
trust) associated with these people in the past two years?
Yes
No
Give details
4
Item Location of Item Name of Creditor Amount Owed Value of Item
Item Location of Item Name of Creditor Amount Owed Value of Item
Name Address
Phone
b. Where are the accounting records located?
c. What was the date of the last annual financial statement?
d. Was the company registered for GST?
Yes
If registered, please provide details:
21.
Is the company currently involved in any court case?
Yes
No
If yes, state the nature of the case, the name of the court, the name of the other party
and the solicitor representing you.
22.
Is the company a member of Bartercard or any similar organisation?
Yes
No
Give d
etails
23.
Does the company have in its possession any item that is subject to Retention of Title?
Yes
No
Give details
24.
Has any creditor seized items within the last 6 months pursuant to a Retention of Title claim?
Yes
No
Give details
25a.
Who was responsible for completing the company’s day to day accounting records?
Name Registered
GST
Number
Invoice Basis
Payment Basis Hybrid Basis Type of Registration:
Period covered
by last return
Frequency of returns
1 month 2 months
6 months
5
No
e.
Were the following records kept? Not Sure
Are these
records
computerised?
Location of records
Cash book – Cash in / Cash out
Cheque Butts – (since commencement
period)
Deposit Butts – of last prepared accounts
Current Cheque and Deposit Books
Bank Statements
Receipt Books
Creditors Invoices
Debtors Ledgers & Current Invoices
Ledgers
Journals
Copies of Annual Financial Statements
Hire Purchase Agreements
Contract Papers & Other Legal
Documents
Asset Register
Stock Sheets
GST Records
Wage Records
Employment Contracts
Constitution
Minute Book
Register of Shareholders
Register of Directors
Director Certificates
Interests Register
Communications with Shareholders
Correspondence
6
f.
Were any company records kept on a computer?
Yes
No
What accounting package is used?
Where is the computer located?
Who can access these records?
Is a full back-up available, including software?
Yes
No Give details
26. CAUSE OF LIQUIDATION
What do you believe is the
PRIMARY
cause of the failure of the company?
Tick ONE box only.
11. Excessive drawings
12. Inability to collect debts due to disputes, faulty work
or bad debts
13. Failure to keep proper books of account and costing
records
14. Lack of sufficient working capital
15. Failure to provide for taxation
16. Seasonal conditions including floods and drought
17. COVID-19
1. Inability to recover costs
2. Adverse legal action or lack of funds to finance legal
action
3. Liabilities due to guarantees
4. Failure of another business organisation
4. Ill health or absence of health insurance records
5. Domestic discord or relationship breakdowns
including falling out of directors
6. Withdrawal of credit facilities
7. Economic conditions including external influences,
competition, increases in costs and lack of sales
8. Lack of business ability including under quoting or
failure to assess potential of business
9. Excessive overheads including interest payments
Which other numbers describe
CONTRIBUTING
causes to the failure of the company?
7
18. None of the above. Give details
Name of Account Bank and Branch Account number Account type
(Cheque, savings etc)
Balance
Name of Company How many
Location of Certificate (if applicable)
or FIN number
Approximate Value
Name of Policy Owner Name of Insurance Company Type of Policy Date paid up to Surrender Value
Type of security Name and Address of Property’s owner
Value of security
PART C – FINANCIAL CIRCUMSTANCES (Assets and Liabilities)
This information will be used to assess the company’s financial position.
27.
List any bank accounts (including building society, overseas funds, credit union, etc)
28.
Do any of the company’s bank accounts contain monies held in trust for third parties and / or were deposited for a
specific purpose?
Yes
No
Give details
29.
Does the company own any shares? (including Government inflation bonds, bonus bonds, unit trust investments, company shares etc)
30.
Does the company have any insurance policies?
Yes
No
31.
Does the company hold security over any property, eg mortgage, debenture or chattel security?
Yes
No
If so, please state
Description of property secured
8
Address of property
Nature of interest (joint tenant, tenant in common, absolute ownership)
Name of Mortgagee or other Chargeholder
Approx market value $ Amount Owing $ Approx Net Value $
Address of property
Nature of interest (joint tenant, tenant in common, absolute ownership)
Name of Mortgagee or other Chargeholder
Approx market value $ Amount Owing $ Approx Net Value $
Address of property
Nature of interest (joint tenant, tenant in common, absolute ownership)
Name of Mortgagee or other Chargeholder
Approx market value $ Amount Owing $ Approx Net Value $
32. REAL ESTATE
(Give details of any land or buildings that the company owns)
Property 1
Is this property insured?
Yes
No
Name of Insurance
Company
Expiry date
If this property is on the market please supply details including asking price, name of agent and how long it has been for sale.
Property 2
Is this property insured?
Yes
No
Name of Insurance
Company
Expiry date
If this property is on the market please supply details including asking price, name of agent and how long it has been for sale.
Property 3
Is this property insured?
Name of Insurance
Yes
No
Company
Expiry date
If this property is on the market please supply details including asking price, name of agent and how long it has been for sale.
9
Type of vehicle eg car, boat Registration Number
Make, model, year
Present location Registered owner
Insurance company Amount insured for $
Current WOF ( Yes / No)
Condition
Odometer
Estimated resale value $
Less amount owed on HP or to secured creditor (if any) $ Net Value $
Name of security holder
Address of security holder
Type of vehicle eg car, boat Registration Number
Make, model, year
Present location Registered owner
Insurance company Amount insured for $
Current WOF ( Yes / No)
Condition
Odometer
Estimated resale value $
Less amount owed on HP or to secured creditor (if any) $ Net Value $
Name of security holder
Address of security holder
Type of vehicle eg car, boat Registration Number
Make, model, year
Present location Registered owner
Insurance company Amount insured for $
Current WOF ( Yes / No)
Condition
Odometer
Estimated resale value $
Less amount owed on HP or to secured creditor (if any) $ Net Value $
Name of security holder
Address of security holder
33. MOTOR VEHICLES
(a) Current Motor Vehicles
(This includes all cars, motorcycles, trailers, caravans, campervans, boats etc the company
currently uses or owns)
Vehicle 1
Vehicle 2
Vehicle 3
10
Type of vehicle eg car, boat Registration Number
Make, model, year
Present location Registered owner
Insurance company Amount insured for $
Current WOF ( Yes / No)
Condition
Odometer
Estimated resale value $
Less amount owed on HP or to secured creditor (if any) $ Net Value $
Name of security holder
Address of security holder
Make, Model, Year
Registration Number
Sale Price $ When sold & details of payment
Name, address and contact phone number of purchaser
Make, Model, Year
Registration Number
Sale Price $ When sold & details of payment
Name, address and contact phone number of purchaser
Make, Model, Year
Registration Number
Sale Price $ When sold & details of payment
Name, address and contact phone number of purchaser
Vehicle 4
(b) Previously Owned Motor Vehicles
(Give particulars of any motor vehicles the company has sold over the last two years)
Vehicle 1
Vehicle 2
Vehicle 3
11
Value
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Value
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Estimated value $
Amount owed $
Net value $
Name Physical & postal
address
Goods/Services
provided
Amount
owed
Estimated $
recoverable
34. PLANT AND EQUIPMENT (including implements, fixtures and fittings but excluding motor vehicles which should be described in question
Description of Item
Identifying
numbers or characters
Type of Security
(if any)
Security Holder
35. STOCK (including livestock and crops)
Description of Item
To whom secured
36. BOOK DEBTS (Who owes the company money)
provided
Date
12
Job description incl
contractor’s contact details
Term of contract Work to be completed Estimated cost
to complete
Amount still to
realise
Amount paid to
date
Description of Item Cost Approximate Value
Description
of asset
Net amount
received
What did the
company do with the
money?
Name and address of
agent / solicitor /
broker
37. INCOMPLETE CONTRACTS
Goodwill
If the business can be sold as a going concern, what value would you estimate the goodwill
to be – take into account the value of any lease key money paid, turnover figures etc.
$
38. OTHER ASSETS
( Please record any other assets and their values not already declared on this form)
39. ASSET DISPOSALS
Has the company sold any assets including land and buildings since the last set of annual accounts?
(Do not include motor vehicles)
Yes
No
Give details
40. ARE ANY DOCUMENTS / ASSETS HELD IN SAFE CUSTODY?
Yes
No
Give details
13
Name Address Amount
Name and
address of
secured creditor
Type of security
Approx market value
of items secured
Amount Net Value
Name of Creditors Address
GST / PAYE / Holiday
Pay / Wages
Period of claim Amount owed
41. CURRENT ACCOUNTS
Provide details of all director / shareholder or other current accounts with the company.
“Owed to” or “
owed
by” company
42. CREDITORS
43. Secured Creditors
– (Do not include securities over real estate and motor vehicles already described.)
Have any creditors taken action to enforce their security?
Yes
No Give details
b. Preferential Creditors
– list Inland Revenue for GST, PAYE and also wages and holiday pay owing to employees.
14
Card Holder Card Type eg BNZ, Warehouse, Mobil Amount owed
c. Credit Cards
(Please give details relating to any credit store or fuel cards where the company has liability for the debt)
Total $
d. Unsecu
red Creditors
– Use additional paper if necessary and attach to form
Name of Creditor
Postal address
Goods / Services
Supplied
Amount owed $
What you do now
If you have written other details down on separate paper, pin them to this document.
DECLARATION THAT THE CONTENTS OF THIS DOCUMENT ARE TRUE AND CORRECT
I,
in my capacity as
to / of the company state that the particulars contained in this document are true and correct.
Signed
Date
15
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STATEMENT OF AFFAIRS In Liquidation Companies Act 1993 (Ministry of Business, Innovation and Employment New Zealand)

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Completed 21 January 2021

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