How to complete the business rescue services client submission form
Note that all fields marked with an asterisk (*) are compulsory - failing which the form will not be submitted!
Your contact details
*
Your name:
*
Company name:
*
Land line number:
*
Cell phone number:
*
Email address:
Your capacity relative to the financially distressed company/CC
*
(Choose Option)
Manager of
Consultant to
Lawyer representing
Business rescue practitioner representing
Director representing
Shareholder of
Creditor of
Registered trade union representing employees
Employee or representative of employees
Legal form of the financially distressed firm
*
Legal entity:
(Choose Option)
Company
Close Corporation
Information required to determine the firm's Public Interest Score
*
Average number of employees at the end of the past financial year
*
Third party liability at the end of the past financial year (R'm)
*
Turnover at the end of the past financial year (R'm)
*
Number of individuals at the end of the past financial year, in the case of a profit company, to directly or indirectly have a beneficial interest in any of the company's issued securities
or
Number of individuals at the end of the past financial year, in the case of a non-profit company, to be a member of the company, or a member of an association that is a member of the company
For more information, see Regulation 26(2) .
Degree of financial distress
*
Factual insolvency
it appears to be reasonably likely that the company/CC will become insolvent (liabilities exceeding assets):
(See Section 128 (1)(f)(ii) ).
(Choose Option)
Already true
Within the ensuing 1 month
Within the ensuing 2 months
Within the ensuing 3 months
Within the ensuing 4 months
Within the ensuing 5 months
Within the ensuing 6 months
*
Commercial insolvency
it appears to be reasonably unlikely that the company/CC will be able to pay all of its debts as they fall due and payable:
(See Section 128 (1)(f)(i) ).
(Choose Option)
Already true
Within the ensuing 1 month
Within the ensuing 2 months
Within the ensuing 3 months
Within the ensuing 4 months
Within the ensuing 5 months
Within the ensuing 6 months
*
Funds for survival until the business rescue plan is approved by creditors
Most companies and CCs die during business rescue due to lack of funds to pay the business rescue practitioner, and ongoing mission critical expenditure e.g. suppliers on a COD basis, salaries, wages, etc. Do you have funds available to survive during business rescue for longer than a month?
(Choose Option)
Yes
No
Causes of financial distress
*
Check all causes that are applicable.
Any additional causes of distress?
Feel free to further elaborate.
Economic viability
*
Your business is financially distressed.
The business rescue plan need to demonstrate that your financial distress is of a temporary nature and that your business is economically viable.
Why do you believe the business is economically viable?
Business rescue status
*
Have liquidation proceedings been initiated by or against the company/CC?
(Choose Option)
Yes
No
*
Have your overdraft facilities been cancelled and your ceded debtors book been called up?
(Choose Option)
Yes
No
*
The company/CC is presently:
(Choose Option)
Not in business rescue
In voluntarily business rescue
In voluntarily business rescue but with an objection
In compulsory business rescue
Voluntarily business rescue refers to section 129: Company resolution to begin business rescue proceedings .
Voluntarily business rescue but with an objection refers to section 130: Objections to company resolution .
Compulsory business rescue refers to section 131: Court order to begin business rescue proceedings .
Company/CC profile
Industry:
Typical products / services:
Estimated market share:
Office locations:
Bank(s):
No. of years in business:
Brief history of your business:
Ownership - % per shareholder/member):
Unionised?
(Choose Option)
Not unionised
Unionised
CRS Business Rescue services requested
*
Check all that are applicable.
