IN THE HIGH COURT IN MALAYA AT JALAN DUTA

COMPANIES WINDING-UP No: WA-28NCC-742-11/2017

In the matter of the Companies Act, 1965

and

In the matter of ACUAN UNGGUL SDN BHD

PROOF OF DEBT GENERAL FORM

I, Zulkifli bin Mohd Fuad, I/C No. xxxx of Acuan Unggul Sdn Bhd (589751-X), Block A T01
U04 Pusat Perniagaan Presint 8, Jalan P8C/1, Presint 8, 62250 Putrajaya, make oath (solemnly,
sincerely and truly affirm) and say:

(c) That I am duly authorized, under the seal of the Company herein after named, to
make the proof of debts on its behalf.

1. That the above-named Company was, at the date of the order for Winding-Up the same,
viz: the 26 day of January 2017 and still is justly and truly indebted to ACUAN
UNGGUL SDN BHD (589751-X) in the sum of Ringgit Malaysia Four Hundred Twenty
Thousand, Six Hundred Fifty and Five Cents (RM 420, 615.00) for the demand of
invested amount with regards to construction work as agreed between Acuan Unggul Sdn
Bhd (589751-X) and POSC TI Sdn Bhd (973085-P) in Contract No:
KL.POSCTI/AUSB/LA/28052015-1 as shown by the account endorsed herein, for which
sum or any part thereof I say that I have not nor hath the above named company or any
person by our order to my knowledge or belief for our used had or received any manner
of satisfaction or security whatsoever:
 SCHEDULE

Date Drawer Acceptor Amount Due Date

ACUAN STAFF OF RM 102, 600.00 30/01/2016

18/01/2016 UNGGUL SDN ACUAN
BHD UNGGUL SDN
BHD
(SALARY)

ACUAN POSC TI SDN RM 280, 000.00 30/01/2016

18/01/2016 UNGGUL SDN BHD
BHD

ACUAN - RM 38, 015.05 30/01/2016

18/01/2016 UNGGUL SDN
BHD

Sworn or Affirmed at )
(Signature of Deponent)
In the State of )

This XX day of XX 20 XX )

Before me,

Note: The proof cannot be admitted for voting at the First Meeting unless it is properly
completed and lodge with the Official Receiver before the time named in the notice convening
the meeting.
 INDORSED ACCOUNT

Particular of account referred to on the other side

(credit should be given for contra accounts)

Dated Consideration Amount Remarks

The vouchers (if any) by
which the account can be
substantiated should be set
out here
29/05/2015 The details of the invested sum as
per contract number
KL.POSCTI/AUSB/LA/28052015
-1: a contract to carry out entrance
and landscape works at Taman
Ilmu Terengganu, Mukim Tembila,
Besut, Terengganu Darul Iman

Deponent’s Signature
 YOU SHOULD ATTEND CAREFULLY TO THESE DIRECTIONS

(a) Fill in full name, address and occupation of deponent. If proof made by creditor strike
out clauses (b) and (c). If made by clerk of creditor strike out (c). If by clerk or agent of
the company strike out (b).

(d) Insert “me and to C.D. and E.E., my co-partners in trade (if any)” or, if by clerk or agent
insert name, address and description of principal.

(e) State consideration (as goods sold and delivered by me (and my said partner) to the
company between the dates of (or moneys advance by me in respect of the
undermentioned bill of exchange) or as the case may be).

(f) “My said partners or any of them ‘or’ the above-named creditor” (as the case may be).

(g) “My” or “Our” or “their” or “this” (as the case may be).

(h) (Here state to the particulars of all securities held, and where the securities are on the
property of the company assess the value of the same, and if any bills or other negotiable
securities be held, specify them in the schedule).