Form 19 Commercial court with jurisdiction_____________________ Business number of the file __________________________ Debtor (name and surname / company or title, Personal Identification Number or VAT number, address / headquarters) ___________________________________________________________________________ TABLE OF REPORTED CLAIMS, SEPARATE SATISFACTION RIGHTS AND EXCLUSION RIGHTS TABLE OF REPORTED CLAIMS Ordinal Name and Amount Amount of Legal basis number surname / Creditor's Address / of confirmed basis for for of company VAT / tax creditor reported claim reported confirmed reported or creditor number headquarters claim claim claim (kn) claim name (kn) Amount of disputed Label of enforcement claim Reason for disputing claim document if the claim is based on enforcement document (kn) TABLE OF SEPARATE SATISFACTION RIGHTS Name and Public Amount of Part of Legal basis Address / surname / Separate register claim that assets that Ordinal of separate creditor company satisfaction where is the number satisfaction headquarters or separate Creditor's separate protected separate rights satisfaction satisfaction by separate satisfaction
Form 19 Commercial court with jurisdiction_____________________ Business number of the file __________________________ Debtor (name and surname / company or title, Personal Identification Number or VAT number, address / headquarters) ___________________________________________________________________________ TABLE OF REPORTED CLAIMS, SEPARATE SATISFACTION RIGHTS AND EXCLUSION RIGHTS TABLE OF REPORTED CLAIMS Ordinal number of reported claim Name and surname / company or creditor name Creditor's VAT / tax number Address / creditor headquarters Amount of reported claim (kn) basis for reported claim Amount of confirmed claim (kn) Legal basis for confirmed claim Amount of disputed claim (kn) Reason for disputing claim Label of enforcement document if the claim is based on enforcement document TABLE OF SEPARATE SATISFACTION RIGHTS Ordinal number Name and surname / company or separate satisfaction Separate satisfaction Creditor's Address / creditor headquarters Public register where separate satisfaction Amount of claim that is protected by separate Legal basis of separate satisfaction rights Part of assets that the separate satisfaction
O19%20TABLE%20OF%20REPORTED%20CLAIMS,%20SEPARATE%20SATISFACTION%20RIGHTS%20AND%20EXCLUSION%20RIGHTS.docx