Form E

[Under Regulation 7(2)(ca) of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016] To The General Manager (IP Division) Insolvency and Bankruptcy Board of India Subject: Annual statement of professional fee of insolvency professional. Sir / Madam, 1. I, [Insert name] hereby submit the annual statement of professional fee earned (whether received or not) by me from my services as an insolvency professional in the financial year [insert financial year], as under: Sl. No. Name of Debtor Services rendered as (IRP / RP / Liquidator / Trustee / Other, if any) Professional fee as an insolvency professional for the year (Rs.) 1 2 3 Total 104 Inserted by Notification No. IBBI/2018-19/GN/REG036 dated 11th October, 2018 (w.e.f. 11.10.2018).

2. The following amounts are payable to the Board: Sl. No. Under regulation Amount Payable (Rs.) 1 Regulation 7(2)(ca) 2 Regulation 15, being interest from … to ….. Total 3. A sum of Rs. …, as worked out in Para 2 above, has been deposited into the account of the Board, vide….. .. 4. I, [insert name], hereby affirm that – i. all information contained in this statement is true and correct in all material respects and ii. no material information relevant for the purpose of this statement has been suppressed. Yours faithfully, Place: (Name) Date: ------------- (Registration Number)] 105