Form 4 20 Rule 4 34 - CVL 995/99 The Insolvency Act 1986 Statement of Company's Affairs Pursuant to section 95/99 of the insolvency Act 1986 For Official Use To the Registrar of Companies Company Number 08111729 Name of Company Kubla: Khan Restaurant Ltd T/AS Kublai Riverside Restaurant & Gril |/We Mark S Goldstein, Kingswood Court, 1 Hemtock Close, Kingswood, Surrey, KT20 GQW the liquidator(s) of the above named company attach a statement of the company affairs as at 06 March 2015 Signed Date 08 March 2015 Mark Goldstein Associates Limited | QL Kingswood Court For Official Use 1 Hemlock Close Insolvency Section Kingswood Surrey, KT20 6QW Ref KUB0001/MSG/MDG Software Supphed by Tumkey Computer Technology Limited Glasgow COMPANIES HOUSE Rule 4 34-CVL Form 4 19 Statement of Affairs Statement as to affairs of Kublai Khan Restaurant Ltd T/AS Kublai Riverside Restaurant & Grill on the 6 March 2015 the date of the resolution for winding up Statement of truth | beleve that the facts stated in this Statement of Affairs are true Full Name Anica Ma uwe Signed ys Madde ” a Dated 6 Haeex Fos Kublai Khan Restaurant Ltd T/AS Kublat Riverside Restaurant & Grill Statement Of Affairs as at 6 March 2015 A- Summary of Assets Estimated to Assets Book Value Realise £ £ Assets subject to fixed charge: Assets subject to floating charge: Uncharged assets: Estimated total assets available for preferential creditors NIL Signature doe oda. Date_ gg rider 901s Kublai Khan Restaurant Ltd T/AS Kublai Riverside Restaurant & Grill Statement Of Affairs as at 6 March 2015 Ai - Summary of Liabilities Estimated to Realise £ Estimated total assets available for preferential creditors (Carried from Page A) NIL Liabilities Preferential Creditors - NIL Estimated deficiency/surplus as regards preferential creditors NIL Debts secured by floating charge pre 15 September 2003 Other Pre 15 September 2003 Floating Charge Creditors NIL NIL Estimated prescribed part of net property where applicable (to carry forward) NIL Estimated total assets available for floating charge holders NIL Debts secured by floating charges post 15 September 2003 NIL Estimated deficiency/surplus of assets after floating charges NIL Estimated prescribed part of net property where applicable (brought down) NIL Total assets available to unsecured creditors NIL Unsecured non-preferential claims (excluding any shortfall to floating charge holders) Trade & Expense Creditors 116,641 24 Employees 3,520 00 Shareholder Loan 185,000 00 HM Revenue & Customs - PAYE & NIC 3,890 70 Director's loan 15,000 00 324,051 94 Estimated deficiency/surplus as regards non-preferential creditors (excluding any shortfall in respect of F.C’s post 14 September 2003) (324,051 94) Estimated deficiency/surplus as regards creditors (324,051 94) Issued and called up capital Ordinary Shareholders 100 00 100 00 Estimated total deficiency/surplus as regards members (324,151 94) Signature oe Madihs Date 6°" prec FOS Mark Goldstein Associates Limited Kublai Khan Restaurant Ltd T/AS Kublai Riverside Restaurant & Grill B - Company Creditors Key Name Address £ CA00 Anita Impex Ltd 60 Burns Way, Hounslow, Middx, TW5 9BA CBa0 Barclaycard Commercial 71,000 00 PO Box 3000, Teesdale Business Park, Stockton On Tees, CB01 Barclays Bank Pic TS17 6YG 2,980 64 7-11 St Jones Hill, Clapham Junction, London, SW111 CB02 BES Commercial Gas TR Parkside Stand, Fleetwood 2,068 85 ccoo Town Football Club, Park Avenue , Fleetwood, TY7 6TX Cory Commercial South East Commercial Services, Crown House, Mucking 3,486 93 Whaft Road, Mucking, 250 00 Stanford-le-Hope, Essex, SS17 ORN CE00 EDF Energy Major Business Customer Services, Gadeon House, Grenad ier Road, Exeter Business 11,960 03 Park, Exeter, EX1 3UT CHO00 H M Revenue & Customs Insolvency & Securities, 3rd Floor Euston Tower, 286 Cmoo Mr Adil Mattk Euston Road, London, NW1 3UQ 3,890 70 14 Furze Lane, Purley, Surrey, CR8 3EG Csoo Mr Ikram Majeed Sehgat 10,000 00 C/O Danmurr, 170 Church Road, Mitcham, Surrey, CR4 CT00 Thames Water Utilttes 3BW 175,000 00 PO Box 286, Swindon, SN38 2RA Cwoo0 Wandsworth Council 2,575 14 Business Rates Service, PO Box 65993, Town Hall, EA0O Mr Guizar Ahmad Wandsworth High Street, SW18 9LB 9 Bellamy House, Garret Lane, London, SW17 OLS 17,819 65 EMao0 Mr Victor Mughal 2,600 00 23 Arundel Road, Croydon, Surrey, CRO 2EP EPOO Mr Muhammad Afzal Ahmed Paswal 920 00 55C Hathaway Road, Croydon, Surrey, CRO 2TQ 4,500 00 14 Entries Totalling 309,051.94 Signature Le wk Page 1 of 1 — Mark Goldstein Associates Limited Kublai Khan Restaurant Ltd T/AS Kublai Riverside Restaurant & Grill C - Shareholders Key Name Address Pref Ord Other Total HMOO Mr Aniq Maltk 14 Furze Lane, Purley, Surrey, CR8 3EG HS00 Mr Ikram Majeed Sehgal 0 30 C/O Danmurr, 170 Church Road, Mitcham, Surrey, 0 30 CR4 3BW 0 70 0 70 2 Entries Totalling 100 Signature yo Maduk Page 1 of 1