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:*

PrefixFirst NameLast Name
Your reference:*
(Uw referentie:)
Telephone number*

Country CodeArea CodePhone Number
Mobile number:

Country CodeArea CodePhone Number
Facsimile:(Fax:)

Country CodeArea CodePhone 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?*

YesNo
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:) Annulerenof
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:) Annulerenof
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: