No. 7/2018 Cap. 6:07 INSOLVENCY THIRD SCHEDULE STATEMENT IN RESPECT OF PROPOSED PRE-LIQUIDATION COMPOS!TlON (Section 119 and s48 (6)) PART A PERSONAL PARTICULARS OF DEBTOR Full name: ......... . Address: .................................................................................................................................. . (Documents in connection with the composition may be delivered to the debtor at this address until such time as he or she has notified the administrator of a change of address) Date of birth:.. .. ... .. .... .... ........ . .. .. . ... . .. ...... . .................................... . Identity number, if one has been assigned: ...................................... . Marital status: ............. .. . . ..... .. ........................ . If married, statefull name of spouse ("spouse" means a person's(a) partner in a marriage; (b) partner in a customary union or customary marriage according to customary law; (c) civil union partner as defined in section 2 of the Civil Union Act, 2006 (Act No. 17 of 2006); or (d) partner in a relationship in which the parties live together in a manner resembling a partnership contemplated in paragraphs (a), (b), or (c), even if one or both are in such a partnership with another partner;) Date of birth of spouse: .......................................................................................... . Identity number of spouse, if one has been assigned ................................ . Date of marriage ........................................................................................................................................ . whether the matrimonial property system has changed since entering into the marriage and, if so, the nature of the change........... .. ... . ............................................................................... . Whether the debtor's estate has been placed under administration during the last five years or whether it is under administration at present and, if so, the date of the administration order and whether it has been concluded ................................................... . Whether the debtor has during the last six months lodged a composition with a magistrate for submission to creditors ............................................................................................................... . Whether the debtor's estate has been liquidated during the last ten years and, if so, the date of liquidation and the Division of the High Court that issued the liquidation order............................................................. ................................................................... .. 340

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