Claims Form – Beige Assure Limited

Part - One

Full Name

Phone Number

Tax Identification Number (TIN)

I state that as at the commencement of its Official Liquidation, the debtor was indebted to the above-named creditor in the sum of .

Total of your claim

Please Select As Appropriate

That security for the payment of the whole or any part of the above amount is not held.

The following security or guarantee is held for the payment of the whole or any part of the above amount.

Attach Supporting Document(s)

Type of Security/ Name of Guarantor

Estimated Value of Guarantee/Property Secured GHs Security/Guarantee Given

Please Attach Supporting Evidence for A, B and C.

A. The values and due dates of provable debts claimed by the creditor to be outstanding in favour of the creditor against the company (In Official Liquidation) and the nature and value of the securities held by the creditor in respect of the debts.
Attach Document(s)

B. The values and due dates of the obligations outstanding in favour of the company against the creditor on the date on which the company entered into Official Liquidation, the nature and value of securities of any description held by the company regarding the outstanding obligations.
Attach Document(s)

C. The total values of the debts, obligations and securities.
Attach Document(s)

Part Two – Details Of Transactions

Please follow the instructions carefully to submit your form

Download and complete the document below with accurate information, then sign.
After fully completing it, scan and upload it here.

Part - One

Please Attach Supporting Evidence for A, B and C.

Part Two – Details Of Transactions

Please follow the instructions carefully to submit your form

Click the button below to upload and submit the completed claims form.