An appeal may be preferred under Section 211, within a period of thirty days of receipt of the order, in the manner prescribed in Part III of the 9[National Company Law Appellate Tribunal Rules, 2016].
Form A
APPLICATION FOR CERTIFICATE OF REGISTRATION
[Under Regulation 4 of the Insolvency and Bankruptcy Board of India (Information Utilities) Regulations, 2017]
To
The Chairperson
The Insolvency and Bankruptcy Board of India
[Insert address]
From
[Name and address]
Subject: Application for grant or renewal of certificate of registration as information utility
Madam/Sir,
1. I, being duly authorized for the purpose, hereby apply on behalf of [name and address of the applicant] for
(a) grant of certificate of registration as information utility, or
(b) renewal of certificate of registration as information utility,
and enclose a copy of the board resolution authorizing me to make this application to and correspond with the Board in this respect.
2. A copy of
(a) the memorandum of association,
(b) the articles of association,
(c) the bye-laws,
(d) the business plan and
(e) the exit management plan of the applicant is enclosed.
3. I, on behalf of [insert name], affirm that the applicant is eligible to be registered as an information utility.
4. I, on behalf of [insert name], hereby affirm that
(a) all information contained in this application is true and correct in all material respects,
(b) no material information relevant for the purpose of this application has been suppressed, and
(c) registration granted or renewed in pursuance of this application may be cancelled summarily if any information submitted is found to be false or misleading in material respects at any stage.
5. If granted registration, I, on behalf of [insert name], undertake to comply with the requirements of the Code, the rules, regulations, guidelines or directions issued thereunder, and such other conditions and terms as may be contained in the certificate of registration or be specified or imposed by the Board subsequently.
ANNEXURE TO FORM A
Part I
GENERAL
1. Name of the applicant.
2. Address of registered office and principal place of business of the applicant.
3. Corporate Identity Number (CIN).
4. PAN.
5. Name, designation and contact details of the person authorised to make this application and correspond with the Board in this respect.
Part II
MEMORANDUM OF ASSOCIATION, ARTICLES OF ASSOCIATION AND BYE-LAWS
6. Please state if the memorandum of association, articles of association and bye-laws provide for all matters as required in, and are consistent with the Insolvency and Bankruptcy Board of India (Information Utilities) Regulations, 2017 and the Code.
Part III
SHAREHOLDING AND FINANCIAL STRENGTH
7. Please provide details of the persons holding more than 5%, directly or indirectly, of the paid-up equity share capital or total voting power of the applicant.
| Sl. No. |
Name and address of the shareholder |
PAN/Passport No. and country of issue/company registration number |
Percentage of shareholding in the applicant company and/or holding company |
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8. Do persons resident outside India in aggregate hold more than 49% of the paid-up equity share capital or total voting power of the applicant? Please provide details.
9. Who exercises control over the applicant? Please provide details.
10. Do persons resident outside India exercise control over the applicant? If so, please provide details.
11. Please provide audited financial statements of:
(a) a company holding more than 5% of the paid-up equity share capital or total voting power of the applicant (if any),
(b) a company who is in control of the applicant (if any),
(c) promoter company (if any),
(d) the applicant company itself, of the last three years or from the date of incorporation of the company, whichever is less.
Part IV
DIRECTORS AND EMPLOYEES
12. Please provide the details of the applicant's Board of Directors, key managerial personnel and compliance officer, if any:
| Sl. No. |
Name and address of the director |
DIN and PAN |
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13. Please provide number of employees, category-wise.
Part V
INFRASTRUCTURE
14. Please provide the details of infrastructure the applicant currently has and proposes to have to enable it to discharge its functions as an information utility, including
a. Technology
b. Data Security
c. Facilities for hosting the data center
d. Grievance redressal and disciplinary proceedings
e. Any further plan for additional/improved infrastructure to be indicated.
Part VI
BUSINESS PLAN
15. Please provide a summary of the applicant's Business Plan.
16. Please provide the time frame in which the applicant will be able to provide the services of an information utility from the date of registration.
Part VII
EXIT MANAGEMENT PLAN
17. Please provide a summary of the applicant's Exit Management Plan, including the manner in which users will be enabled to transfer their information to other utilities.
Part VIII
FIT AND PROPER CRITERIA
18. Please provide information to demonstrate that the persons holding more than 5% of the paid-up equity share capital or total voting power of the company, the promoters, the key managerial personnel, the directors of the applicant and the applicant are fit and proper persons.
| Sl. No. |
Name |
Relationship to the applicant |
DIN/CIN/PAN |
Details of conviction orders, if any, against the person |
Details of restraining orders, if any, against the person |
Is the person an undischarged insolvent or bankrupt? If yes, please provide details |
Details pertaining to the character, reputation and integrity of the person |
Any other information |
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Part IX
COMPLIANCE
[For applications for renewal of registration]
19. Please provide details of the information utility's compliance with the conditions of its certificate of registration.
20. Please provide details of the information utility's compliance with the Code, rules, regulations, guidelines and directions thereunder, during the period of registration.
Please provide any other details you consider relevant in support of the application.
Sd
Authorized Signatory
(Name)
(Designation)
Date:
Place:
Form B
[Under Regulation 5 of the Insolvency and Bankruptcy Board of India (Information Utilities) Regulations, 2017]
The Insolvency and Bankruptcy Board of India
Certificate of Registration No. ..
The Insolvency and Bankruptcy Board of India hereby grants/renews this/the certificate of registration to/of .[insert name and address] to act as an information utility in accordance with the Insolvency and Bankruptcy Code, 2016.
The certificate of registration is valid from [insert start date] to [insert end date] and may be renewed.
Sd
(Name and Designation)
(For and on behalf of Insolvency and Bankruptcy Board of India)
Place:
Date:
Form C
[Under Regulation 20 of the Insolvency and Bankruptcy Board of India (Information Utilities) Regulations, 2017]
Information may be accepted in this form with such modifications as the information utility deems fit
A. Details relating to Creation of Debt
| Details of the user submitting information |
| 1. |
Full Name (Please provide your First Name, Middle Name and Last Name) |
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| 2. |
Relationship of the person submitting information to the Debt (Debtor/Creditor/Debenture Trustee/Guarantor/please specify any other) |
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| 3. |
Unique Identifier as registered with an Information Utility |
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| 4. |
Date of Birth/Date of incorporation |
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| 5. |
Full Address |
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| 6. |
Telephone No. |
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| 7. |
Mobile No. |
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| 8. |
Email ID |
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| 9. |
Fax No. |
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| 10. |
Signature |
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| Details of Other Parties to the Debt (Apart from the person submitting the debt) |
| Details of Parties (please add as many parties as may be applicable) |
| 11. |
Relationship of the party to the debt (Debtor/Creditor/Debenture Trustee/Guarantor/please specify any other) |
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| 12. |
Full Name (Please provide your First Name, Middle Name and Last Name) |
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| 13. |
Unique Identifier as registered with an Information Utility, if any |
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| 14. |
Date of Birth/Date of incorporation |
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| 15. |
Full address |
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| 16. |
Telephone No. |
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| 17. |
Mobile No. |
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| 18. |
Email ID |
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| 19. |
Fax No. |
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| Details of the Debt |
| 20. |
Unique identifier of the debt, in case the debt has previously been recorded in any Information Utility |
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| 21. |
Loan Agreement Number/Loan Account Number |
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| 22. |
Date of Loan Agreement |
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| 23. |
Nature of the Debt (Operational/Financial) |
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| 24. |
Currency of the Debt |
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| 25. |
Date of disbursement of the debt |
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| 26. |
Date of maturity of the debt |
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| 27. |
Date of expiry of the debt |
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| 28. |
Date of Renewal of the Debt |
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| 29. |
Amount of debt owed on the date of creation |
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| 30. |
Amount of debt owed currently |
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| 31. |
Rate of Interest (as updated from time to time) |
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| 32. |
Security on Debt (If yes, please fill Section B dealing with Details relating to Creation of Security on Debt) |
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| 33. |
Host bank and Repayment Account number, if any |
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| 34. |
Details of repayment schedule of the debt, if any |
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| 35. |
Details of terms of demand loan, if any |
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| 36. |
Details of confirmed balance, if any |
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| 37. |
List out Documents Attached as Proof: |
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A. Copy of the Loan Agreement (as revived from time to time) |
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B. Repayment Schedule (If in possession of the submitter) |
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C. Balance Confirmation |
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D. Balance Sheet and Cash Flow Statements (If the submitter is the Debtor) |
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E. Any other document relating to creation of debt/change in terms of the debt |
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B. Details relating to Creation of Security on Debt (If not applicable, please write NA)
| 38. |
Security Interest Type (Mortgage/charge/hypothecation/assignment/pledge, etc.) |
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| 39. |
Asset Type (Movable, immovable, intangible) |
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| 40. |
Type of Security (Vehicle, inventory, receivable, equipment, Plot, etc.) |
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| 41. |
Joint Security Interest (Yes or No) |
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| 42. |
Number of Security Interest Holders |
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| 43. |
Security Interest ID (As per CERSAI) |
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| 44. |
Description of the security (Number, Identification Marks, etc.) |
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| 45. |
Date of Creation of Security Interest |
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| 46. |
Date of Modification of Security Interest |
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| 47. |
Final amount secured |
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| 48. |
Value of Security |
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| 49. |
Date of Valuation |
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| 50. |
List out documents attached as proof: |
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A. Copy of the Security Deed |
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B. Copy of the Valuation Report |
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C. Proof of Registration with CERSAI |
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D. Copy of the Certificate of Registration of Charge |
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E. Any other document relating to creation of security |
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C. Details relating to Default of Debt (If not applicable, please write NA)
| Details of the Default |
| 51. |
Date of Default |
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| 52. |
Days past due |
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| 53. |
Total amount due and default amount |
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| 54. |
Date and amount of last payment |
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| 55. |
Suit filed or not |
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| 56. |
Documents attached as proof of default |
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