Submission online claim McGregor Group

FORM TO SUBMIT A CLAIM IN THE BANKRUPTCIES OF THE COMPANIES OF MCGREGOR GROUP
Name of debtor *
(Naam schuldenaar)
Name of creditor: *
(Naam schuldeiser:)
Address: *
(Street name and no. / Straatnaam en huisnummer)
City: *
(Stad)
Postal code: *
(Postcode)
Country: *
IBAN: *
BIC Code: *
Contact person: *

Prefix First Name Last Name
Your reference: *
(Uw referentie:)
Telephone number *

Country Code Area Code Phone Number
Mobile number:

Country Code Area Code Phone Number
Facsimile:(Fax:)

Country Code Area Code Phone Number
E-mail address: *
The undersigned submits the following claim for verification purposes:

(Ondergetekende meldt de volgende vordering ter verificatie aan:)
Is a bank guarantee provided to you? *

Yes No
Please upload: *
Claim and specification
(Vordering en specificatie)
Currency: *
(Valuta:)
Principal: *
(hoofdsom:)
VAT: (if applicable)
(BTW:) indien van toepassing
Total: *
Totaal
Description nature of the claim:
(Omschrijving aard van de vordering:)
Proof of claim: *

Upload file(s)
(Bewijsstukken vordering:) Annuleren of
If you have a preferred and/of secured claim, kindly fill in the details below:

(Indien u een bevoorrechte en/of gesecureerde vordering heeft, kunt u dat hieronder aangeven:)
Preferred and/or secured claim?
(Bevoorrechte en/of gesecureerde vordering?)
Retention of title? *
(Recht van eigendomsvoorbehoud?)
Description preferential and/or security right:
(Omschrijving voorrecht en/of zekerheidsrecht:)
Proof of preferential and/or security right:

Upload a File
(Bewijsstukken voorrecht en/of zekerheidsrecht:) Annuleren of
Should be Empty:

FORM TO SUBMIT A CLAIM IN THE BANKRUPTCIES OF THE COMPANIES OF MCGREGOR GROUP

The undersigned submits the following claim for verification purposes:

If you have a preferred and/of secured claim, kindly fill in the details below: