Corporations Regulations 2001

(subregulation 5.6.54(1))

A.C.N or A.R.B.N:

Corporations Act 2001

NOTICE OF REJECTION OF FORMAL PROOF OF DEBT OR CLAIM

Limited

To of

1. Your claim against the company set out in the formal proof of debt or claim of (name of person submitting original proof of debt or claim) made on (date) has been *wholly disallowed/*disallowed to the extent of (particulars of part of claim disallowed)/*allowed in the sum of $ /*allowed to the extent of your claim for (particulars of part of claim allowed).

2. My grounds for disallowance of (particulars of part of claim referred to) are as follows:

3. If you are dissatisfied with my determination as set out above, you may appeal against it, no later than (number of days, being not less than 14) days after the service of this notice or, if the Court allows, within any further period, to the *Federal Court of Australia/*the Supreme court of (State or Territory). If you do not do so, your claim will be assessed in accordance with this determination.

Dated

Signature of liquidator

Address

* Omit if inapplicable