(1) Till such time, rules of procedure for conduct of proceedings under the Code are notified, the applications under rules 6 and 7 shall be filed and dealt with by the Adjudicating Authority in accordance with
(i) rules 20, 21, 22, 23, 24 and 26 of Part III of the National Company Law Tribunal Rules, 2016 made under section 469 of the Companies Act, 2013 (18 of 2013); or
(ii) rule 3 of the Debt Recovery Tribunal (Procedure) Rules, 1993 made under section 36 of the Recovery of Debts and Bankruptcy Act, 1993 (51 of 1993) and regulations 3, 4, 5 and 11 of the Debt Recovery Tribunal Regulations, 2015 made under section 22 of the Recovery of Debts and Bankruptcy Act, 1993, as the case may be.
(2) The application and accompanying documents shall be filed in electronic form, as and when such facility is made available and as directed by the Adjudicating Authority:
Provided that till such facility is made available, the applicant may submit accompanying documents, and wherever they are bulky, in electronic form, in scanned, legible portable document format in a data storage device such as compact disc or a USB flash drive acceptable to the Adjudicating Authority.
FORM A
[See rule 6(1)]
APPLICATION BY GUARANTOR TO INITIATE BANKRUPTCY PROCESS.
[Under rule 6 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019]
[Date]
To,
The Adjudicating Authority
[Address]
From,
[Name and address of the guarantor]
In the matter of [name of the guarantor]
Subject: Application to initiate bankruptcy process in respect of [name of the guarantor].
Madam/Sir,
I/We hereby submit this application to initiate a bankruptcy process in respect of [name of guarantor]. The details for the purpose of this application are set out below
Part I
| PARTICULARS OF THE GUARANTOR |
| 1. |
Title and full name |
|
| 2. |
Date of birth and e-mail address |
|
| 3. |
Any other name by which the debtor is or has been known (as applicable) |
|
| 4. |
Address (i) Present (ii) Permanent (iii) Business |
|
| 5. |
Occupation/Business/Profession |
|
| 6. |
Annual income in the preceding year (in Rupees) |
|
| 7. |
List of associates of the guarantor, including relatives, who may be creditors |
Name |
Age |
Address |
| |
|
|
| 8. |
Bank account details (Joint and Several) |
Account number |
IFSC code |
Name of Branch and Branch address |
| |
|
|
| 9. |
Identification numbers |
Aadhaar number |
Passport number |
PAN |
GSTIN |
| |
|
|
|
| 10. |
Contact number(s) |
Home |
Mobile |
Business |
| |
|
|
| 11. |
List of assets of guarantor and immediate family as on the application date. Note: this will include all assets, irrespective of them being excluded assets. Please mention which assets are the excluded assets. |
Immovable |
Description |
Estimated value |
Excluded asset or not |
| Movable |
Description |
Estimated value |
Excluded asset or not |
| |
Vehicles |
|
|
|
| Shares in listed companies |
|
|
|
| Shares in other companies |
|
|
|
| Life insurance policy |
|
|
|
| Jewellery |
|
|
|
| Pension policy |
|
|
|
| Investment in mutual funds |
|
|
|
| Investment in other funds |
|
|
|
| Investment in partnerships and other business concerns |
|
|
|
| Any other movable property |
|
|
|
| 12. |
Number of directorships held in the last three years (along with name of company in which directorship is held and Directors Identification Number) and CIN of such companies |
|
| 13. |
Marital status (single, married, divorced, widowed, co-habiting, separated, or specify any other) |
|
| 14. |
Details regarding guarantee given by guarantor (in addition to information in serial number 1-13 of this part) |
| |
Name of corporate debtor for which guarantee is given |
|
| Any current or past position held in the corporate debtor |
|
| Identification number of the corporate debtor |
|
| Whether corporate debtor is an associate as per section 79(2) of the Code (state how) |
|
| Any securities held in corporate debtor for whom guarantee is given |
|
| 15. |
Where the guarantor is not a resident in India, the name and address of the person authorized to accept the service of process on guarantor's behalf, along with the authority |
|
Part-II
[Please complete this Part if you have been self-employed, or a partner in a firm. If not, go to Part III.]
| BUSINESS PARTICULARS OF GUARANTOR |
| 1. |
Name of business and form of business |
|
| 2. |
Details of registration, if any |
|
| 3. |
Description of business |
|
| 4. |
Business address |
|
| 5. |
Annual income of guarantor |
|
| 6. |
If business organization is a firm, details mentioned below: |
|
| (i) |
Date of joining firm |
|
| (ii) |
Capital subscription as per latest balance sheet |
|
| (iii) |
Profit sharing as per latest balance sheet |
|
| (iv) |
Name, address and authority of person submitting application on behalf of the firm |
|
| 7. |
Commencement date of business and date of close of operations (if applicable) |
|
| 8. |
Address where books of accounts/accounting records are kept (including soft copy records) |
|
| 9. |
Whether employees to whom debt owed (state yes or no, and if yes, details to be mentioned in Part III) |
|
Part - III
| PARTICULARS OF DEBT [CREDITOR WISE, AS APPLICABLE] |
| 1. |
Name(s) of creditor(s) |
|
| 2. |
Address |
Present |
Permanent |
Business |
| |
|
|
| 3. |
Total debt (including any interest or penalties) |
|
| 4. |
Amount of debt in default |
|
| 5. |
Interest or penalties, if any |
|
| 6. |
Date when the debt was due |
|
| 7. |
Date when the default occurred |
|
| 8. |
Nature of the debt |
|
| 9. |
Secured debt including particulars of security held, the date of its creation, estimated value of security as per the creditor |
|
| 10. |
Unsecured debt |
|
| 11. |
Details of retention of title arrangements (if any) in respect of goods to which the debt refers |
|
| 12. |
Record of default with the information utility, if any |
|
| 13. |
List of documents attached to this application in order to prove the existence of debt and the amount in default |
|
| 14. |
Statement by guarantor in respect of excluded debts |
I [guarantor] hereby state that the debt(s) for which the bankruptcy process application is filed does not include any (i) liability to pay fine imposed by a court or tribunal; (ii) liability to pay damages for negligence, nuisance or breach of a statutory, contractual or other legal obligation; (iii) liability to pay maintenance to any person under any law for the time being in force; (iv) liability in relation to a student loan; (v) any other debt prescribed under section 79(15)(e) of the Code. |
Part-IV
| PARTICULARS OF & DECLARATION BY INSOLVENCY PROFESSIONAL (IF PROPOSED TO ACT AS BANKRUPTCY TRUSTEE) |
| 1. |
Title and full name |
|
| 2 |
Address |
Present |
Permanent |
Business |
| |
|
|
| 3 |
E-mail address(es) |
|
| 4 |
Contact number |
Home |
Mobile |
Business |
| |
|
|
| 5. |
Declaration by insolvency professional |
I, [name of insolvency professional], an insolvency professional registered with [name of insolvency professional agency] having registration number [registration number] have been proposed as the insolvency professional by [name of applicant guarantor] in connection with the proposed bankruptcy process of [name of the guarantor]. I hereby: (i) agree to accept appointment as the insolvency professional if an order of appointment is passed by the Adjudicating Authority; (ii) state that the registration number allotted to me by the Board is [insert registration number] and that I am currently qualified to practice as an insolvency professional; (iii) disclose that I am currently serving as an insolvency professional/resolution professional/liquidator/bankruptcy trustee in [insert number and details of the proceedings]; (iv) certify that there are no disciplinary proceedings pending against me with the Board or [name of the insolvency professional agency he is a member of]; (v) affirm that I am eligible to be appointed as an insolvency professional in respect of the debtor in accordance with Regulation 3 of the Insolvency and Bankruptcy Board of India (Bankruptcy Process for Personal Guarantors to Corporate Debtors) Regulations, 2019; (vi) make the following disclosures in accordance with the code of conduct for insolvency professionals as set out in the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [insert disclosures, if any]. (Signature of the insolvency professional) |
Yours sincerely,
| Signature of guarantor/person authorized to act on behalf of the guarantor [Please enclose the authorisation document if this application is being submitted on behalf of the guarantor] |
| Name in block letters |
| Address of person signing |
DECLARATION
I, [Name of applicant], currently residing at [insert address], hereby declare and state as follows:
1. In respect of my application for bankruptcy, I have relied on the documents specified below: [Please list the documents relied on].
2. The contents of the said application along with the said documents are true, valid and genuine to the best of my knowledge, information and belief and no material facts have been concealed therefrom.
Date:
Place:
(Signature of the applicant)
VERIFICATION
I, [name of applicant], do hereby verify that the contents of this application are true and correct to my knowledge and belief. Nothing is false and nothing material has been concealed there from.
Verified at _______ on this ________ day of _______20__
______
Applicant's signature.
ATTACHMENTS: List of documents to be appended to the application:
1. All records of the insolvency resolution process in respect of the guarantor, including the following
(i) Application for the insolvency resolution process;
(ii) Order(s) of the Adjudicating Authority
(a) accepting/rejecting the application under serial number (i) above under section 100 of the Code, as the case may be;
(b) approving/rejecting the repayment plan under section 114 of the Code, as the case may be;
(c) declaring that the repayment plan has not been fully implemented under section 118 and entitling the debtor to apply for bankruptcy, as the case may be;
(d) any other order that may have been passed by the Adjudicating Authority in relation to the insolvency resolution process.
2. All documents mentioned in serial number 13 of Part III of this form.
3. Copy of the income tax returns with detailed computation of the income of the guarantor, or the firm, as the case may be, for the previous three years.
4. Copy of the personal guarantee contract.
5. Copies of entries in a bankers book in accordance with the Bankers Books Evidence Act, 1891 (18 of 1891)
6. The latest and complete copy of the financial contract reflecting all amendments and waivers to date.
7. Copies of relevant ownership and title documents for all assets.
8. Copy of the authorisation, wherever required under this form.
9. Proof that the application fee has been paid.
10. Documentary evidence of all information sought in each entry for each part of the form.
11. A statement of affairs of the guarantor made up to a date not earlier than two days from the date of the application including the following information and supporting documents, namely
(i) debtor's assets (inclusive of excluded assets) and liabilities for the previous three years;
(ii) secured and unsecured debts (inclusive of excluded debts mentioned in serial number 14 of Part III of the form) with names of the creditors, and all requisite details for the previous three years;
(iii) particulars of debt owed by guarantor to associates of the guarantor for the previous three years;
(iv) guarantees given in relation to any of the debts of the guarantor, and if any of the guarantors is an associate of the guarantor;
(v) financial statements with all annexures and schedules for the business owned by the guarantor, or of the firm in which the guarantor is a partner, as the case may be, for the previous three years, if applicable;
(vi) wealth tax statements filed by the guarantor, if any, for the previous five years.
(vii) Income statement of the guarantor, for the previous three years.
(viii) Payment of indirect taxes including GST for the previous three years.
FORM B
[See rule 7(1)]
APPLICATION BY CREDITOR TO INITIATE BANKRUPTCY PROCESS
[Under rule 7 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019]
[Date] .
To,
The Adjudicating Authority
[Address]
From,
[Name and address of the creditor]
In the matter of [name of the guarantor]
Subject: Application to initiate bankruptcy process in respect of [name of the guarantor] under the Insolvency and Bankruptcy Code, 2016.
Madam/Sir,
[Name of the creditor], hereby submits this application to initiate a bankruptcy process in the case of [name of guarantor]. The details for the purpose of this application are set out below:
Part - I
| PARTICULARS OF APPLICANT |
| 1. |
Title and full name |
|
| 2. |
Date of birth and e-mail address |
|
| 3. |
Contact number(s) |
Home |
Mobile |
Business |
| |
|
|
| 4. |
Identification number of creditor |
Aadhaar number |
CIN |
PAN |
GSTIN |
| |
|
|
|
| 5. |
Address |
Present |
Permanent |
Business |
| |
|
|
Part - II
| PARTICULARS OF THE GUARANTOR |
| 1. |
Title and full name |
|
| 2. |
Date of birth and e-mail address (to the extent known) |
|
| 3. |
Any other name by which the guarantor is or has been known (as applicable) (to the extent known) |
|
| 4. |
Address |
Present |
Permanent |
Business |
| |
|
|
| 5. |
Occupation/Business/Profession |
|
| 6. |
Annual income (to the extent known) |
|
| 7. |
List of associates of the guarantor, including relatives, who may be creditors (to the extent known) |
Name |
Age |
Address |
| |
|
|
| 8. |
Bank account details (Joint and Several) |
Account number |
IFSC code |
Name of the Bank and Branch address |
| |
|
|
| 9. |
Identification numbers |
Aadhaar number |
Passport number |
PAN |
GSTIN |
| |
|
|
|
| 10. |
Contact number(s) |
Home |
Mobile |
Business |
| |
|
|
| 11. |
List of assets of guarantor as on the application date (to the extent known) Note: this will include all assets of debtor, irrespective of them being excluded assets. |
Immovable |
Description |
Estimated value |
Excluded asset or not |
| Movable |
Description |
Estimated value |
Excluded asset or not |
| |
Vehicles |
|
|
|
| Shares in listed companies |
|
|
|
| Shares in other companies |
|
|
|
| Life insurance policy |
|
|
|
| Jewelry |
|
|
|
| Pension policy |
|
|
|
| Investment in mutual funds |
|
|
|
| Investment in other funds |
|
|
|
| Investment in partnerships and other business concerns, |
|
|
|
| Any other movable property |
|
|
|
| 12. |
Number of directorships held in the last three years (along with name of company in which directorship is held and Director Identification Number) and CIN of such companies (to the extent known) |
|
| 13. |
Marital status (single, married, divorced, widowed, co-habiting, separated, or specify any other) (to the extent known) |
|
| 14. |
Details regarding guarantee given by guarantor (in addition to information in serial numbers 1-13 of this part) |
| Name of corporate debtor for which guarantee is given |
|
| Any current or past position held in the corporate debtor (to the extent known) |
|
| Identification number of the corporate debtor |
|
| Whether corporate debtor is an associate (to the extent known) |
|
| Any securities held in corporate debtor for whom guarantee is given |
|
| 15. |
Where the guarantor is not a resident in India, the name and address of the person authorised to accept the service of process on guarantor's behalf, along with the authority |
|
Part-III
| PARTICULARS OF DEBT |
| 1. |
Total debt (including any interest or penalties) |
|
| 2. |
Amount in default |
|
| 3. |
Date on which debt was due |
|
| 4. |
Date on which default occurred |
|
| 5. |
Nature of the debt |
|
| 6. |
Secured debt including particulars of security held, the date of its creation, its estimated value as per the creditor (as applicable) |
|
| 7. |
Unsecured debt (as applicable) |
|
| 8. |
Details of retention of title arrangements (if any) in respect of goods to which the debt refers (attach a copy) |
|
| 9. |
Details of any mutual credit, mutual debts, or other mutual dealings between the guarantor and the creditor, which may be set-off against the claim (attach proof) |
|
| 10. |
Particulars of an order of a court, tribunal or arbitral panel adjudicating on the default, if any (attach a copy of the order) |
|
| 11. |
Record of default with the information utility, if any (attach a copy) |
|
| 12. |
Details of succession certificate, or probate of a will, or letter of administration, or court decree (as may be applicable), under the Indian Succession Act, 1925 (10 of 1925) (attach a copy) |
|
| 13. |
Provision of law, contract or other document under which debt has become due (attach a copy) |
|
| 14. |
A statement of bank account where deposits are made or credits received normally by the creditor in respect of the debt of the debtor (attach a copy) |
|
| 15. |
List of documents attached to this notice in order to prove the existence of debt and the amount in default |
|
| 16. |
Statement by the secured creditor under section 123(2) of the Code |
Tick whichever is applicable In the event a bankruptcy order accepting the application is passed by the Adjudicating Authority, I shall relinquish my security mentioned in serial number 6 for the benefit of all the creditors of the debtor. The application is only in respect of unsecured debt as per the details mentioned in serial number 7. |
| 17. |
Statement by creditor in respect of excluded debts |
I [creditor] hereby state that the debt(s) for which the bankruptcy process application is filed does not include any (i) liability to pay fine imposed by a court or tribunal; (ii) liability to pay damages for negligence, nuisance or breach of a statutory, contractual or other legal obligation; (iii) liability to pay maintenance to any person under any law for the time being in force; (iv) liability in relation to a student loan; (v) any other debt prescribed under section 79(15)(e) of the code. |
Part-IV
| PARTICULARS OF & DECLARATION BY INSOLVENCY PROFESSIONAL (IF PROPOSED TO ACT AS BANKRUPTCY TRUSTEE) |
| 1. |
Title and full name |
|
| 2. |
Address |
Present |
Permanent |
Business |
| |
|
|
| 3. |
E-mail address(es) |
|
| 4. |
Contact number |
Home |
Mobile |
Business |
| |
|
|
| 5. |
Declaration by insolvency professional |
I, [name of insolvency professional], an insolvency professional registered with [name of insolvency professional agency] having registration number [registration number] have been proposed as the insolvency professional by [name of applicant guarantor] in connection with the proposed bankruptcy process of [name of the guarantor]. I hereby: (i) agree to accept appointment as the insolvency professional if an order of appointment is passed by the Adjudicating Authority; (ii) state that the registration number allotted to me by the Board is [insert registration number] and that I am currently qualified to practice as an insolvency professional; (iii) disclose that I am currently serving as an insolvency professional/resolution professional/liquidator/bankruptcy trustee in [insert number and details of the proceedings]; (iv) certify that there are no disciplinary proceedings pending against me with the Board or [name of the insolvency professional agency he is a member of]; (v) affirm that I am eligible to be appointed as an insolvency professional in respect of the debtor in accordance with regulation 3 of the Insolvency and Bankruptcy Board of India (Bankruptcy Process for Personal Guarantors to Corporate Debtors) Regulations, 2019; (vi) make the following disclosures in accordance with the code of conduct for insolvency professionals as set out in the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [insert disclosures, if any]. (Signature of the insolvency professional) |
Yours sincerely,
| Signature of creditor/person authorised to act on behalf of the creditor [Please enclose the authorisation document if this application is being submitted on behalf of the creditor] |
| Name in block letters |
| Address of person signing |
List of documents to be attached to the application:
1. All records of the insolvency resolution process in respect of the guarantor, including the following
(i) Application for the insolvency resolution process;
(ii) Order(s) of the Adjudicating Authority
(a) accepting/rejecting the application under serial number (i) above, as the case may be;
(b) approving/rejecting the repayment plan, as the case may be;
(c) entitling the creditor to apply for bankruptcy;
(iii) any other order that may have been passed by the Adjudicating Authority in relation to the insolvency resolution process.
2. All documents mentioned in serial number 15 of Part III of this form.
3. Copy of the income tax returns with detailed computation of the income of the guarantor, or the firm, as the case may be, for the previous three years, if available.
4. Copy of the personal guarantee contract.
5. Copy of the authorisation, wherever required under this form.
6. Proof that the application fee has been paid.
7. Documents evidencing the debt and the default in relation to the debt, as may have been provided by the guarantor at any point in time, if available.
8. Documents evidencing the assets, liabilities, income and any other relevant information as may have been provided by the guarantor at any point in time, if available.
9. Documentary evidence of all information sought in each entry for each part of the form.
Form C
[See rule 9(1)]
Public Notice
[Under rule 9(1) of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019]
FOR THE ATTENTION OF THE CREDITORS OF [Full Name and title of Bankrupt (personal guarantor of (name of corporate debtor)]
Notice is hereby given that the [Debt Recovery Tribunal/National Company Law Tribunal in case of bankrupt under section 60 of the Code] has ordered the commencement of a bankruptcy process against the [name of bankrupt] residing at [last known address of the bankrupt] on [bankruptcy commencement date].
The creditors of [name of the bankrupt], are hereby called upon to submit their claims with proof on or before [insert the date falling seven days from date of issue of public notice] to the bankruptcy trustee at [address].
The last date for submission of claims of creditors shall be [date]. The creditors may submit their claims through electronic means, or by hand or registered post or speed post or courier.
Additional details of the bankruptcy trustee: [Name, last known address, e-mail address, phone number and the registration number of the bankruptcy trustee]
Note: Submission of false or misleading claims with proof shall attract penalties or imprisonment in accordance with the provisions of the Insolvency and Bankruptcy Code, 2016 and any other applicable laws.
Date and Place:
FORM D
[See rule 10(1)]
NOTICE TO CREDITOR
[Under rule 10 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019]
To
[Name and address of creditor]
From
[Adjudicating Authority]
Notice is hereby given that the [Debt Recovery Tribunal/National Company Law Tribunal in case of bankrupt under section 60 of the Code] has ordered the commencement of a bankruptcy process against the [title and full name of bankrupt] residing at [last known address of the bankrupt] on [bankruptcy commencement date].
You have been mentioned as a creditor of the bankrupt as per the documents submitted in the application for the bankruptcy process. You are hereby called upon to submit a claim with proof of the debt due to you on or before [insert the date falling seven days from date of issue of public announcement] to the bankruptcy trustee at [address].
The last date for submission of claims shall be [date]. You may submit your claim through electronic means, or by hand or registered post or speed post or courier.
Additional details of the bankruptcy trustee: [Name, last known address, e-mail address, phone number and the registration number of the bankruptcy trustee]
Note: Submission of false or misleading claims with proof shall attract penalties or imprisonment in accordance with the provisions of the Insolvency and Bankruptcy Code, 2016 and any other applicable laws.
Date and Place:
FORM E
[See rule 11]
STATEMENT OF FINANCIAL POSITION OF BANKRUPT
[Under rule 11 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019]
Part I
| Relevant particulars |
| 1. |
Full name of bankrupt |
|
| 2. |
Address |
Present |
Permanent |
Business |
| |
|
|
| 3. |
Bank account details (Joint and Several) |
Account Number |
IFS C Code |
Name of Bank and Bank Branch |
| |
|
|
| 4. |
List of assets of bankrupt and immediate family as on the application date for the previous three years. Note: this will include all assets of bankrupt, irrespective of them being excluded assets. Please mention the assets which may be excluded assets. |
Immovable property |
Description |
Estimated value |
Excluded asset or not |
| |
|
|
|
| |
|
Movable property |
Description |
Estimated value |
Excluded asset or not |
| |
|
Vehicles |
|
|
|
| |
|
Shares in listed companies |
|
|
|
| |
|
Shares in other companies |
|
|
|
| |
|
Life insurance policy |
|
|
|
| |
|
Jewellery |
|
|
|
| |
|
Pension policy |
|
|
|
| |
|
Investment in mutual funds |
|
|
|
| |
|
Investment in other funds |
|
|
|
| |
|
Investment in partnerships and other business concerns |
|
|
|
| |
|
Any other property not covered above |
|
|
|
| 5. |
The following information is required in relation to the guarantee given by the guarantor: |
| i. |
Name of corporate debtor for which guarantee is given |
|
| ii. |
Any current or past position held in the corporate debtor |
|
| iii. |
Whether corporate debtor is an associate |
|
| iv. |
Any securities held in corporate debtor for whom guarantee is given |
|
| 6. |
Name and address of person resident in India authorised to accept the service of process on bankrupt's behalf (if applicable) |
|
Part II
| FINANCIAL INFORMATION |
| 1. |
Statement of assets and liabilities for the previous three years |
|
| 2. |
Secured and unsecured debts, with complete details of the creditors including name and postal address, the total amount due, amount in default and details of the security, for the previous three years |
|
| 3. |
Details of the debts owed to associates of the bankrupt, for the previous three years |
|
| 4. |
Details of guarantees given in relation to any of the debts of the guarantor, and if any of the guarantors is an associate of the guarantor |
|
| 5. |
Details of the business owned by the bankrupt, or of the firm in which the bankrupt is a partner, as the case may be, for the previous three years, if applicable |
|
| 6. |
Details of the wealth tax statements filed by the bankrupt, if any, for the previous five years. |
|
| 7. |
Details of trusts held by bankrupt and/or immediate family of bankrupt |
|
| 8. |
Any other relevant information |
|
FORM F
[See rule 12(1)]
CLAIM WITH PROOF BY A CREDITOR
[Under rule 12 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019]
[Date]
To
The Bankruptcy Trustee
[Name of the Bankruptcy Trustee]
[Address as set out in public notice]
From
[Name and address of the creditor]
Subject: Submission of claims with proof.
Madam/Sir,
[Name of the creditor], hereby submits this proof of claim in respect of the bankruptcy process in the case of [name of bankrupt]. The details for the same are set out below:
| S. No. |
Particulars |
| 1. |
Title and full name of creditor |
|
| 2. |
Identification number of creditor |
Aadhar |
PAN |
CIN |
GSTIN |
| |
|
|
|
| 3. |
Address |
Present |
Permanent |
Business |
| |
|
|
| 4. |
Total amount of claim (Including any interest as at the bankruptcy commencement date) |
|
| 5. |
Details of documents by reference to which the debt can be substantiated. |
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| 6. |
Details of any dispute as well as the record of such dispute Note: Dispute will include suits, arbitration proceedings, and other judicial proceedings contesting the existence or validity of the debt. |
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| 7. |
Details of how debt was incurred and the date when debt incurred |
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| 8. |
Details of any mutual credit, mutual debts, or other mutual dealings between the bankrupt and the creditor which may be set-off against the claim |
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| 9. |
Details of any retention of title arrangements in respect of goods or properties to which the claim refers |
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| 10. |
Details of the bank account to which the amount of the claim or any part thereof can be transferred pursuant to a repayment plan |
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| 11. |
Details of any security held (including value and date when it was given) |
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| 12. |
For secured creditors only |
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Tick whichever is applicable security interest is being enforced Security interest is being relinquished. |
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If security is being relinquished, please complete the statement of relinquishment of secuirty interest in the column on the right. |
I, [name of secured creditor], hereby release and relinquish my security interest and any claim, right, lien or interest in any property based on such security interest, other than the right to receive dividends as per the Code, in [insert description of the subject and nature of security interest], which was created by [name of bankrupt], on [insert date of creation of security interest] on account of [insert description of circumstances leading to creation of security interest]. Signature of the secured creditor, or the authorised signatory. |
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If security is being realised, provide details of any action that has been taken to enforce/realise the security. |
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If security is being realised, specify balance amount of debt which is being claimed. |
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| 13. |
List of documents attached to this proof of claim in order to prove the existence and non-payment of claim due to the creditor |
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| 14. |
Details of bank account to which the share of creditor's proceeds from bankruptcy can be deposited. |
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| Signature of creditor or person authorised to act on his behalf [Please enclose the authority if this is being submitted on behalf of a creditor] |
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| Name in block letters |
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| Address of person signing |
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DECLARATION
I, [name of claimant], currently residing at [insert address], declare and state as follows:
1. [Name of bankrupt], the debtor was, at the bankruptcy commencement date, being the day of 20__, justly and truly indebted to me to the sum of INR [insert amount of claim].
2. In respect of my claim of the said sum or any part thereof, I have relied on the documents specified below:
[Please list the documents relied on as evidence of claim]
3. The said documents are true, valid and genuine to the best of my knowledge, information and belief.
4. In respect of the said sum or any part thereof, I have not, nor has any person by my order, to my knowledge or belief, for my use, had or received any manner of satisfaction or security whatsoever, save and except the following:
[Please state details of any mutual credit, mutual debts, or other mutual dealings between the bankrupt and the creditor which may be set-off against the claim.]
Date:
Place:
(Signature of the claimant)
VERIFICATION
I, [Name], the claimant hereinabove, do hereby verify that the contents of this claim with proof are true and correct to my knowledge and belief and no material facts have been concealed therefrom.
Verified at _____ on this ____ day of ____ 201__
(Claimant's signature)