Page:UKSRO 1890.pdf/42
henceforth the substituted form shall be the Form No. 73 referred to in Rule 220 of the said rules.
Dated this twenty-second day of March 1890.
By order of the Board of Trade,
SUBSTITUTED FORM No. 73 above referred to.
Proof of Debt Workmen.
(Title.)
No. (a)[1] 18 .
Re (a)
I (b[2] of the above-named debtor [or the foreman of the above-named debtor (or) on behalf of the workmen and others employed by the above-named debtor] make oath and say:
1. That I [or the said ] w at the date of the receiving order, viz., the day of 18 . and still justly and truly indebted to the several persons whose names, addresses, and descriptions appear in the schedule hereunder written [or hereunto annexed], in the sums severally set against their names in the sixth column of such schedule for wages due to them respectively as workmen or others in my employ [or the employ of the above-named debtor] in respect of services rendered by them respectively to me [or to the above-named debtor] during such periods before the date of the receiving order as are set out against their respective names in the fifth column of such schedule, for which said sums or any part thereof I say that they have not nor hath any of them had or received any manner of satisfaction or security whatsoever.
Schedule above referred to.
| 1. | 2. | 3. | 4. | 5. | 6. |
|---|---|---|---|---|---|
| No. | Full Name of Workman. |
Address. | Description. | Period over which Wages due. |
Amount due. |
| Sworn at this day of one thousand eight hundred and
Before me,
|
Deponent's signature, |