2 Rule 4 34-CVL The Insolvency Act 1986 Form 4 20 5.95/99 STATEMENT OF COMPANY'S AFFAIRS Pursuant to Section 95/99 of the insolvency Act 1986 For official use Company Number 08051374 To the Registrar of Companies Company Number | SURESIGN (NW) LIMITED ‘| |, M J Colman of Leonard Curtis, 20 Roundhouse Court, South Rings Business Park, Bamber Bridge, Preston, Lancashire, PR5 6DA, the Joint Liquidator of the above named Company, attach a statemeptettke affairs as at 16 February 2015 Date 16 February 2015 Presenter's name, address and reference (if any) For official use Leonard Curtis 20 Roundhouse Court South Rings Business Park Bamber Bridge ore win Preston For official use #378 eognot8 COMPANIES HOUSE Rule 4 34-CVL Form 4 19 Statement of Affairs Statement as to affairs of SURESIGN (NW) LIMITED on the 16 February 2015 being a date not more than 14 days before the date of the resolution for winding up Statement of truth | believe that the facts stated in this Statement of Affairs are true Full name jl LAE Signed Dated MY. tA, ~LOIS” CVLMF419 06-04-10 A- Summary of Assets Assets Book Value Estimated to Realise £ £ Uncharged assets Goodwill 8,230 1,500 Plant and Machinery 1,508 1,500 Motor Vehicles 4,771 - Debtors 24,725 - Cash at Bank 1,798 1,798 Stocks 60,000 1,000 Office Furniture and Equipment - 1,000 Estimated total assets avail referential creditors 99,234 6,798 Signature Date / k 2-+ C A1 - Summary of Liabilities Estimated to Realise £ Estimated total assets available for preferential creditors 99,234 6,798 Liabilities Preferential creditors Employee / Employment Rights Act 1996 Claims (est ) Nil (592) Estimated (deficiency) / surplus as regards preferential creditors 99,234 6,206 Estimated prescribed part of net property where applicable (c f/wd) N/A N/A Estimated total assets available for floating charge creditors 99,234 6,206 Debts Secured by floating charges Estimated surplus of assets after floating charges 99,234 6,206 Estimated prescribed part of net property where applicable (b fiwd) N/A NA Total assets available to unsecured creditors 99,234 6,206 Unsecured non-preferential claims (excluding any shortfall to floating charge holders) Employee / Employment Rights Act 1996 Claims (est ) (1,640) H M Revenue & Customs — Corp Tax (est ) (5,502) H M Revenue & Customs - PAYE / NI (est ) (93) H M Revenue & Customs — VAT (est ) (1,707) Trade and Expense Creditors (est } (46) (8,988) Estimated deficiency as regards non-preferential creditors (2,782) Shortfall to floating charge holders (b/fwd) NIA Estimated (deficiency) / surplus as regards creditors (2,782) Issued and called up share capital 100 shares of £1 each 100 Estimated (deficiency) / surplus as regards members (2,882) Signature Date [b-IAK COMPANY CREDITORS Note: You must include all creditors and identify all creditors under hire-purchase, chattel leasing or conditional sale agreements and customers claiming amounts paid in advance of the supply of goods or services and creditors claiming retention of title over property in the company’s possession Name of creditor Address Amount | Details of any security held by | Date security | Value of security or Claimant (with postcode) of debt creditor given £ £ See attached x) Signature Date [b- 2-1f Za B - Company Creditors SA12M Suresign (NW) Limited Code Name & Address Amount of Debt c0001 MB Keehan 100 23 Wyreside Drive Hambleton Poulton-Le-Fylde Lancashire FY6 9DP c0002 HM Revenue & Customs (VAT) 1,707 00 National Insolvency Unit 5th Floor Regian House James Street Liverpool L75 1AD C0003 HM Revenue & Customs (Corporation Tax) 5,502 40 Insolvency Claims Handling Unit Benton Park View Longbenton Newcastle NE98 12ZZ C0004 HM Revenue & Customs (PAYE) 92 80 Durrington Bridge House Barrington Road Worthing West Sussex BN12 4SE C0005 The Insolvency Service 592 00 Redundancy Payments PO Box 15424 Cobalt Square 83-85 Hagley Road Birmingham B16 8QG C0006 United Utilities 100 PO Box 50 Warrington WA55 1AQ C0007 British Telecommuications plc 100 81 Newgate Street London ECIA 7AJ c0008 npower 100 PO Box 583 Hull HUS5 1YU c0009 Santander 42 25 PO Box 1109 Bradford BDi 52J co010 The Insolvency Service 1,640 00 Redundancy Payments PO Box 15424 Cobalt Square 83-85 Hagley Road Birmingham B16 80G Signature Date [b- LZNS* ma, SA12M ~~ Page 1/2 B - Company Creditors SA12M Suresign (NW) Limited Code Name & Address ‘ Amount of Debt £9,580 45 Signature Date /6-L-K~ SA12M oe Coo Lo . Page 2/ 2 _ COMPANY SHAREHOLDERS Name of Shareholder Address (with postcode) No. of shares | Nominal Detatls of Shares held held Value Roger Garside 7 St Martins Close, Carleton, Poulton-Le-Fyide, Lancashire, 100 100 Ordinary FY6 7NT NS TOTALS 100 100 Signature Date [ b- -2-/ « a