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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. Yours faithfully, Sd/- Authorized Signatory (Name) (Designation) Date : Place : 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 authorized to make this application and correspond with the Board in this respect. 52 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 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 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 Relati onship to the applic ant 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 inform ation 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 :
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. Yours faithfully, Sd/- Authorized Signatory (Name) (Designation) Date : Place : 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 authorized to make this application and correspond with the Board in this respect. 52 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 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 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 Relati onship to the applic ant 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 inform ation 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 :