表格28C.doc

HCB (1) /(2) 表格28C FORM 28C 香港特別行政區 原訟法庭 高院破產案件 (2) 年第(1) 宗 IN THE HIGH COURT OF THE HONG KONG SPECIAL ADMINISTRATIVE REGION COURT OF FIRST INSTANCE IN BANKRUPTCY PROCEEDINGS NO.(1) OF(2) 有關(3) Re (3) 資產負債狀況說明書(債務人的呈請) STATEMENT OF AFFAIRS (DEBTOR’S PETITION) 《破產條例》（第6章） BANKRUPTCY ORDINANCE (CHAPTER 6) 請填寫本表格各頁，以顯示你現在的經濟狀況；本表格填妥後即為你的資產負債狀況說明書。 Show your current financial position by completing all the pages of this form which will then be your Statement of Affairs. 誓章 AFFIDAVIT 你在填妥本表格的其他部分後，必須在一名律師、監誓員或獲妥為授權監誓的法院人員面前就本誓章宣誓。 This Affidavit must be sworn before a Solicitor or Commissioner of Oaths or an officer of the court duly authorized to administer oaths when you have completed the rest of this form. 本人(10) I, (10) ， 地址為(18) of (18)  宣誓聲言：在此展示並標明為 ?? A至H表 的各頁，盡本人所知所信，為有關本人在今日日期的資產負債狀況的一份全面、真實及完整的說明書。 Make oath and say that several pages exhibited hereto and marked Lists A to H are to the best of my knowledge and belief a full, true and complete statement of my affairs at today’s date. 在 (13) 宣誓 Sworn at (13) 日期 (11) 簽署 (14) Date (11) Signature(s) (14) 在本人面前 (12) Before me (12) 律師或監誓員或獲妥為授權的人員 A Solicitor or Commissioner of Oaths or Duly authorized officer 在為本誓章監誓前，律師或監誓員務請確定宣誓人的全名、地址及描述已有述明，並務請在印製的表格上任何刪除或其他更改之處簡簽。本誓章如在任何上述方面有所不足，即會被法院拒絕接納，並須重新宣誓。 Before swearing the affidavit, the Solicitor or Commissioner is particularly requested to make sure that the full name, address and description of the deponent are stated, and to initial any crossings-out or other alterations in the printed form. A deficiency in the affidavit in any of the above respects will mean that it will be refused by the court, and will need to be re-sworn. A表 LIST A 有抵押債權人(23) SECURED CREDITORS (23) 是否有人正就你的任何東西提