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Form A
UNIFIED ENROLMENT AND REGISTRATION APPLICATION FORM [Under Regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 and Regulation 10 of Insolvency and Bankruptcy Board of India (Model Bye- Laws and Governing Board of Insolvency Professional Agencies) Regulations, 2016] Part - I TO BE SUBMITTED BY THE APPLICANT <Please affix a recent passport size photo> 100 Inserted by Notification No. IBBI/2022-23/GN/REG088, dated 4th July, 2022 (w.e.f. 04.07.2022). 101 Substituted by Notification No. IBBI/2023-24/GN/REG104, dated 18th September, 2023 (w.e.f. 18.09.2023).
To The Managing Director, <name of the insolvency professional agency> Subject: Application for enrolment as professional member and registration as an insolvency professional Sir / Madam, I hereby apply for - (a) enrolment as a professional member with the <name of the insolvency professional agency> under regulation 10 of Insolvency and Bankruptcy Board of India (Model Bye- Laws and Governing Board of Insolvency Professional Agencies) Regulations, 2016; and (b) registration as an insolvency professional under section 207 of the Insolvency and Bankruptcy Code, 2016 read with regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. My details are as under: A. PERSONAL DETAILS 1. Title (Mr. / Mrs. / Ms. / Other): 2. Name (as per PAN / Aadhaar): 3. Father’s Name: 4. Mother’s Name: 5. Date of Birth: 6. Place of Birth: 7. PAN: 8. AADHAAR No. (if available): 9. Passport No. (if available): 10. GSTIN (if available): 11. DIN / DPIN (if available): 12. Address for Correspondence (Note: This shall be recorded as the registered address): 13. Permanent Address: 14. E-mail Address (Note: This shall be recorded as the registered e-mail address): 15. Mobile No. (Note: This shall be recorded as the registered mobile number): 16. Residential Status: Person resident in India/ Person resident outside India (strike off whichever is not applicable) [in terms of section 3 (24) or 3 (25) of Insolvency and Bankruptcy Code, 2016] B. EDUCATIONAL, PROFESSIONAL AND INSOLVENCY EXAMINATION QUALIFICATIONS
(i) Educational Qualifications [Please provide educational qualifications from Bachelor’s degree onwards] Sl. No. Educational qualification University /College Year of Passing Marks Secured (%) Grade/ Class Remarks, if any (1) (2) (3) (4) (5) (6) (7) (ii) Professional Qualifications [in terms of regulation 5(c)(iv) of IP Regulations] Sl. No. Professional Qualification Institute/ Professional Body Membership No. / Enrolment No. (as the case may be) Date of registration/ enrolment Remarks, if any (1) (2) (3) (4) (5) (6) (iii) Insolvency Examinations Sl. No. Name of the examination /programme Whether qualified or not? (Yes / No) Name of the Institute/ Organisation Marks (%) /Grade/Class (If applicable) Date of passing Remarks, if any (1) (2) (3) (4) (5) (6) (7) 1 Limited Insolvency Examination IBBI 2 Post Graduate Insolvency Programme
3 National Insolvency Programme (iv) Are you a registered valuer? (Yes/No) If yes, (a) IBBI Registration No._______________ (b) Name of Registered Valuer Organisation (RVO) ______________and, (c) RVO Enrolment No.________________ C. WORK EXPERIENCE (i) Are you presently in practice / employment? (Practice / Employment) (ii) Total period in practice (years and completed months): yy / mm (iii) Total period in employment (years and completed months): yy / mm (iv) Details of experience (from the date of enrolment as an Advocate / Chartered Accountant/ Company Secretary / Cost Accountant / After Bachelors’ Degree / After Master’ Degree / After Post Graduate Diploma) SI. No . From Date (dd-mm- yyyy) To Date (dd- mm- yyyy) Employment Practice Area of Work Name and Address of Employer Designation Advocate/ CA/CS/CM A Name of Firm and Firm Registration Number, if applicable (1) (2) (3) (4) (5) (6) (7) (8) D. ADDITIONAL INFORMATION 1. Have you ever been convicted for an offence? (Yes / No) If yes, please give complete along with current status. 2. Is any criminal proceedings pending against you? (Yes / No) If yes, please give complete details along with current status. 3. Have you ever been adjudged as an insolvent/bankrupt, or applied to be declared so? (Yes / No) If yes, please give complete details along with current status.
4. Is there any disciplinary proceeding pending against you or has been taken against you at any time in the preceding three years by the ICAI, ICSI, ICAI (Cost), Bar Council or RVO? (Yes /No) If yes, please give complete details along with current status. 5. Have you ever applied for Enrolment with any Insolvency Professional Agency? (Yes / No) If yes, please give details. Date of application Name of the IPA Status of application Reason of Rejection, if applicable Date of Rejection, if applicable 6. Please provide any additional information that may be relevant for determining fit and proper person eligibility. E. ATTACHMENTS 1. Copy of proof of residence 2. Copy of PAN card, Aadhaar card and Passport 3. Copy of GST Registration Certificate 4. Copy of DIN/ DPIN allotment letter 5. Copies of documents in support of educational qualification, professional qualification, and insolvency examination. 6. Copies of documents demonstrating practice as – (i) a chartered accountant registered with the Institute of Chartered Accountants of India; (ii) a company secretary registered with the Institute of Company Secretaries of India; (iii) a cost accountant registered with the Institute of Cost Accountants of India; or (iv) an advocate enrolled with the Bar Council. 7. Copies of certificate of employment from the employer(s), specifying the period of such employment 8. Financial statements / Income-tax Returns for the last three years. 9. Copy of certificate of professional membership of Registered Valuer Organisation. 10. Evidence of deposit / payment of applicable fee. 11. Details of information with respect to conviction, criminal proceedings, insolvency/bankruptcy order, disciplinary proceedings/actions, and any other additional information relevant for the application, as may be applicable (including brief facts, copy of relevant orders and present status thereof) as separate enclosures. F. UNDERSTANDING
I understand and agree that my enrolment with the <name of insolvency professional agency> and completion of pre-registration educational course, subsequently, does not entitle me to the registration, which is subject to me complying with requirements applicable under the Insolvency and Bankruptcy Code, 2016 read with the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. G. AFFIRMATIONS I affirm that I am eligible to be enrolled as a professional member under the Insolvency and Bankruptcy Board of India (Model Bye-Laws and Governing Board of Insolvency Professional Agencies) Regulations, 2016 read with sections 205 of the Insolvency and Bankruptcy Code, 2016. 2. I affirm that the information furnished by me in this application is correct and complete to the best of my knowledge and belief. 3. I undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016, rules, regulations, guidelines and circulars issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled, the resolutions passed, and directions given by the Board and the Governing Board of such insolvency professional agency and to furnish any additional information as and when called for by the Board or Insolvency Professional Agency. Name and signature of the applicant Place: Date: Part - II TO BE SUBMITTED BY THE PROFESSIONAL MEMBER [For the purposes of registration as an Insolvency Professional] A. ENROLMENT WITH INSOLVENCY PROFESSIONAL AGENCY (1) Professional Membership No./ Enrolment No.: (2) Date of Enrolment: B. PRE-REGISTRATION EDUCATIONAL COURSE Have you completed the Pre-Registration Educational Course? (Yes/No) If Yes, date of completion of Pre-Registration Educational Course: dd/mm/yyyy C. FEE PAYMENT Have you paid the non-refundable application fee to the Board within twelve months before the date of completion of the Pre-Registration Educational Course? (Yes/No) If Yes, date of payment of non-refundable application fee to the Board: dd/mm/yyyy D. INFORMATION UPDATE
Do you wish to update the information submitted in Form A at the time of application seeking enrolment with the Insolvency Professional Agency? (Yes/No) E. AFFIRMATIONS I affirm that I am eligible to be registered as an insolvency professional under the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 read with section 207 of the Insolvency and Bankruptcy Code, 2016. 2. I affirm that the information furnished by me in this application is correct and complete to the best of my knowledge and belief. 3. I undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016, rules, regulations, guidelines and circulars issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled and directions given by the Board and the Governing Board of such insolvency professional agency and to furnish any additional information as and when called for by the Board or Insolvency Professional Agency. F. ATTACHMENTS 1. Copy of certificate of membership with an insolvency professional agency. 2. Copy of certificate of completion of pre-registration educational course. 3. Evidence of deposit / payment of applicable fee. 4. Copy of proof towards information updated in the Form A, wherever applicable. Name and signature of applicant Place: Date: Part - III TO BE SUBMITTED BY THE INSOLVENCY PROFESSIONAL AGENCY [For the purposes of registration as an Insolvency Professional] To, The Executive Director (IP Division) Insolvency and Bankruptcy Board of India Subject: Application for registration as an insolvency professional Sir / Madam, The application for registration received from [Name of the applicant] after obtaining the membership [Professional Membership Number], under section 207 of the Insolvency and Bankruptcy Code, 2016 read with regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [IP Regulations] is hereby submitted to the Board.
We have verified as under: SI. No. Verification Finding 1 Whether the applicant has submitted all the required details under Regulations 4 and 5 of IP regulations (as applicable) in its application and completed the payment for registration as per requirement specified under Regulation 6 of IP Regulations? (Yes/ No) If No, please provide the details. 2 Whether the professional member has completed the pre- registration educational course within twelve months of making payment of application fee to the Board and obtained the completion certificate in this regard? (Yes/No) If Yes, give details and supporting document: (Date of certificate) 3 Whether the insolvency professional agency has granted the professional membership to the applicant after complying with eligibility requirement to become an insolvency professional? (Yes/No) If Yes, give details and supporting document: (Enrolment No) (Date of Enrolment) 4 Whether any disciplinary proceedings are pending, or any disciplinary action has been taken at any time in the preceding three years against the professional member by the ICAI, ICSI, ICMAI, Bar Council or RVO of which applicant is a member. Yes / No. If Yes, give details and supporting document. 5 Whether a regulator ICAI, ICMAI, ICSI, or Bar Council has initiated any criminal proceeding against the professional member and is pending for disposal? Yes / No. If Yes, give details and supporting document. 6 Whether the professional member had an unblemished service records with the last employer if he was in employment? Yes / No. If Yes, give details and supporting document. 7 In case, DIN / DPIN has been furnished by the professional member, whether the status thereof has been verified along with nature of designation held by the professional member? Yes / No. If Yes, give details and supporting document. 8 Whether the name of the professional member appears in the database of Ministry of Corporate Affairs regarding: i. Directors disqualified under section 164 of the Companies Act, 2013, or ii. Proclaimed Offenders under section 82 of the Code of Criminal Procedure, 1973. Yes / No. If Yes, give details and supporting document. 9 Whether the professional member has been penalised by SEBI or CCI in the last three years? Yes / No.
If Yes, give details and supporting document. 10 Whether the name of professional member appears in the list of defaulters of RBI / Credit Information Company? Yes / No. If Yes, give details and supporting document. 11 Whether the professional member has been convicted of any offence? Yes / No. If Yes, give details and supporting document. We have verified the above details submitted by <name of the applicant> who is our professional member with <professional membership no.> and confirm these to be true and correct. We recommend registration of <name of the applicant> as an insolvency professional with IBBI. (Name and Signature) Authorised Officer of the Insolvency Professional Agency (Seal of the Insolvency Professional Agency) Place: Date:] 102
UNIFIED ENROLMENT AND REGISTRATION APPLICATION FORM [Under Regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 and Regulation 10 of Insolvency and Bankruptcy Board of India (Model Bye- Laws and Governing Board of Insolvency Professional Agencies) Regulations, 2016] Part - I TO BE SUBMITTED BY THE APPLICANT <Please affix a recent passport size photo> 100 Inserted by Notification No. IBBI/2022-23/GN/REG088, dated 4th July, 2022 (w.e.f. 04.07.2022). 101 Substituted by Notification No. IBBI/2023-24/GN/REG104, dated 18th September, 2023 (w.e.f. 18.09.2023).
To The Managing Director, <name of the insolvency professional agency> Subject: Application for enrolment as professional member and registration as an insolvency professional Sir / Madam, I hereby apply for - (a) enrolment as a professional member with the <name of the insolvency professional agency> under regulation 10 of Insolvency and Bankruptcy Board of India (Model Bye- Laws and Governing Board of Insolvency Professional Agencies) Regulations, 2016; and (b) registration as an insolvency professional under section 207 of the Insolvency and Bankruptcy Code, 2016 read with regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. My details are as under: A. PERSONAL DETAILS 1. Title (Mr. / Mrs. / Ms. / Other): 2. Name (as per PAN / Aadhaar): 3. Father’s Name: 4. Mother’s Name: 5. Date of Birth: 6. Place of Birth: 7. PAN: 8. AADHAAR No. (if available): 9. Passport No. (if available): 10. GSTIN (if available): 11. DIN / DPIN (if available): 12. Address for Correspondence (Note: This shall be recorded as the registered address): 13. Permanent Address: 14. E-mail Address (Note: This shall be recorded as the registered e-mail address): 15. Mobile No. (Note: This shall be recorded as the registered mobile number): 16. Residential Status: Person resident in India/ Person resident outside India (strike off whichever is not applicable) [in terms of section 3 (24) or 3 (25) of Insolvency and Bankruptcy Code, 2016] B. EDUCATIONAL, PROFESSIONAL AND INSOLVENCY EXAMINATION QUALIFICATIONS
(i) Educational Qualifications [Please provide educational qualifications from Bachelor’s degree onwards] Sl. No. Educational qualification University /College Year of Passing Marks Secured (%) Grade/ Class Remarks, if any (1) (2) (3) (4) (5) (6) (7) (ii) Professional Qualifications [in terms of regulation 5(c)(iv) of IP Regulations] Sl. No. Professional Qualification Institute/ Professional Body Membership No. / Enrolment No. (as the case may be) Date of registration/ enrolment Remarks, if any (1) (2) (3) (4) (5) (6) (iii) Insolvency Examinations Sl. No. Name of the examination /programme Whether qualified or not? (Yes / No) Name of the Institute/ Organisation Marks (%) /Grade/Class (If applicable) Date of passing Remarks, if any (1) (2) (3) (4) (5) (6) (7) 1 Limited Insolvency Examination IBBI 2 Post Graduate Insolvency Programme
3 National Insolvency Programme (iv) Are you a registered valuer? (Yes/No) If yes, (a) IBBI Registration No._______________ (b) Name of Registered Valuer Organisation (RVO) ______________and, (c) RVO Enrolment No.________________ C. WORK EXPERIENCE (i) Are you presently in practice / employment? (Practice / Employment) (ii) Total period in practice (years and completed months): yy / mm (iii) Total period in employment (years and completed months): yy / mm (iv) Details of experience (from the date of enrolment as an Advocate / Chartered Accountant/ Company Secretary / Cost Accountant / After Bachelors’ Degree / After Master’ Degree / After Post Graduate Diploma) SI. No . From Date (dd-mm- yyyy) To Date (dd- mm- yyyy) Employment Practice Area of Work Name and Address of Employer Designation Advocate/ CA/CS/CM A Name of Firm and Firm Registration Number, if applicable (1) (2) (3) (4) (5) (6) (7) (8) D. ADDITIONAL INFORMATION 1. Have you ever been convicted for an offence? (Yes / No) If yes, please give complete along with current status. 2. Is any criminal proceedings pending against you? (Yes / No) If yes, please give complete details along with current status. 3. Have you ever been adjudged as an insolvent/bankrupt, or applied to be declared so? (Yes / No) If yes, please give complete details along with current status.
4. Is there any disciplinary proceeding pending against you or has been taken against you at any time in the preceding three years by the ICAI, ICSI, ICAI (Cost), Bar Council or RVO? (Yes /No) If yes, please give complete details along with current status. 5. Have you ever applied for Enrolment with any Insolvency Professional Agency? (Yes / No) If yes, please give details. Date of application Name of the IPA Status of application Reason of Rejection, if applicable Date of Rejection, if applicable 6. Please provide any additional information that may be relevant for determining fit and proper person eligibility. E. ATTACHMENTS 1. Copy of proof of residence 2. Copy of PAN card, Aadhaar card and Passport 3. Copy of GST Registration Certificate 4. Copy of DIN/ DPIN allotment letter 5. Copies of documents in support of educational qualification, professional qualification, and insolvency examination. 6. Copies of documents demonstrating practice as – (i) a chartered accountant registered with the Institute of Chartered Accountants of India; (ii) a company secretary registered with the Institute of Company Secretaries of India; (iii) a cost accountant registered with the Institute of Cost Accountants of India; or (iv) an advocate enrolled with the Bar Council. 7. Copies of certificate of employment from the employer(s), specifying the period of such employment 8. Financial statements / Income-tax Returns for the last three years. 9. Copy of certificate of professional membership of Registered Valuer Organisation. 10. Evidence of deposit / payment of applicable fee. 11. Details of information with respect to conviction, criminal proceedings, insolvency/bankruptcy order, disciplinary proceedings/actions, and any other additional information relevant for the application, as may be applicable (including brief facts, copy of relevant orders and present status thereof) as separate enclosures. F. UNDERSTANDING
I understand and agree that my enrolment with the <name of insolvency professional agency> and completion of pre-registration educational course, subsequently, does not entitle me to the registration, which is subject to me complying with requirements applicable under the Insolvency and Bankruptcy Code, 2016 read with the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. G. AFFIRMATIONS I affirm that I am eligible to be enrolled as a professional member under the Insolvency and Bankruptcy Board of India (Model Bye-Laws and Governing Board of Insolvency Professional Agencies) Regulations, 2016 read with sections 205 of the Insolvency and Bankruptcy Code, 2016. 2. I affirm that the information furnished by me in this application is correct and complete to the best of my knowledge and belief. 3. I undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016, rules, regulations, guidelines and circulars issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled, the resolutions passed, and directions given by the Board and the Governing Board of such insolvency professional agency and to furnish any additional information as and when called for by the Board or Insolvency Professional Agency. Name and signature of the applicant Place: Date: Part - II TO BE SUBMITTED BY THE PROFESSIONAL MEMBER [For the purposes of registration as an Insolvency Professional] A. ENROLMENT WITH INSOLVENCY PROFESSIONAL AGENCY (1) Professional Membership No./ Enrolment No.: (2) Date of Enrolment: B. PRE-REGISTRATION EDUCATIONAL COURSE Have you completed the Pre-Registration Educational Course? (Yes/No) If Yes, date of completion of Pre-Registration Educational Course: dd/mm/yyyy C. FEE PAYMENT Have you paid the non-refundable application fee to the Board within twelve months before the date of completion of the Pre-Registration Educational Course? (Yes/No) If Yes, date of payment of non-refundable application fee to the Board: dd/mm/yyyy D. INFORMATION UPDATE
Do you wish to update the information submitted in Form A at the time of application seeking enrolment with the Insolvency Professional Agency? (Yes/No) E. AFFIRMATIONS I affirm that I am eligible to be registered as an insolvency professional under the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 read with section 207 of the Insolvency and Bankruptcy Code, 2016. 2. I affirm that the information furnished by me in this application is correct and complete to the best of my knowledge and belief. 3. I undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016, rules, regulations, guidelines and circulars issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled and directions given by the Board and the Governing Board of such insolvency professional agency and to furnish any additional information as and when called for by the Board or Insolvency Professional Agency. F. ATTACHMENTS 1. Copy of certificate of membership with an insolvency professional agency. 2. Copy of certificate of completion of pre-registration educational course. 3. Evidence of deposit / payment of applicable fee. 4. Copy of proof towards information updated in the Form A, wherever applicable. Name and signature of applicant Place: Date: Part - III TO BE SUBMITTED BY THE INSOLVENCY PROFESSIONAL AGENCY [For the purposes of registration as an Insolvency Professional] To, The Executive Director (IP Division) Insolvency and Bankruptcy Board of India Subject: Application for registration as an insolvency professional Sir / Madam, The application for registration received from [Name of the applicant] after obtaining the membership [Professional Membership Number], under section 207 of the Insolvency and Bankruptcy Code, 2016 read with regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [IP Regulations] is hereby submitted to the Board.
We have verified as under: SI. No. Verification Finding 1 Whether the applicant has submitted all the required details under Regulations 4 and 5 of IP regulations (as applicable) in its application and completed the payment for registration as per requirement specified under Regulation 6 of IP Regulations? (Yes/ No) If No, please provide the details. 2 Whether the professional member has completed the pre- registration educational course within twelve months of making payment of application fee to the Board and obtained the completion certificate in this regard? (Yes/No) If Yes, give details and supporting document: (Date of certificate) 3 Whether the insolvency professional agency has granted the professional membership to the applicant after complying with eligibility requirement to become an insolvency professional? (Yes/No) If Yes, give details and supporting document: (Enrolment No) (Date of Enrolment) 4 Whether any disciplinary proceedings are pending, or any disciplinary action has been taken at any time in the preceding three years against the professional member by the ICAI, ICSI, ICMAI, Bar Council or RVO of which applicant is a member. Yes / No. If Yes, give details and supporting document. 5 Whether a regulator ICAI, ICMAI, ICSI, or Bar Council has initiated any criminal proceeding against the professional member and is pending for disposal? Yes / No. If Yes, give details and supporting document. 6 Whether the professional member had an unblemished service records with the last employer if he was in employment? Yes / No. If Yes, give details and supporting document. 7 In case, DIN / DPIN has been furnished by the professional member, whether the status thereof has been verified along with nature of designation held by the professional member? Yes / No. If Yes, give details and supporting document. 8 Whether the name of the professional member appears in the database of Ministry of Corporate Affairs regarding: i. Directors disqualified under section 164 of the Companies Act, 2013, or ii. Proclaimed Offenders under section 82 of the Code of Criminal Procedure, 1973. Yes / No. If Yes, give details and supporting document. 9 Whether the professional member has been penalised by SEBI or CCI in the last three years? Yes / No.
If Yes, give details and supporting document. 10 Whether the name of professional member appears in the list of defaulters of RBI / Credit Information Company? Yes / No. If Yes, give details and supporting document. 11 Whether the professional member has been convicted of any offence? Yes / No. If Yes, give details and supporting document. We have verified the above details submitted by <name of the applicant> who is our professional member with <professional membership no.> and confirm these to be true and correct. We recommend registration of <name of the applicant> as an insolvency professional with IBBI. (Name and Signature) Authorised Officer of the Insolvency Professional Agency (Seal of the Insolvency Professional Agency) Place: Date:] 102