Form C

PROXY FORM (Under regulation 16(2) of the Insolvency and Bankruptcy Board of India (Insolvency Resolution Process for Personal Guarantors to Corporate Debtors) Regulations, 2019) Full name of the guarantor - [Insert matter name / application number for the resolution process] Full name of creditor Address Present Permanent Business Identification Number Aadhaar Number PAN CIN GSTIN E-mail I being [insert name of creditor] holding [insert % of voting share] in the debt of the guarantor, hereby appoint- 1. Full name Address Present Permanent Business Identification Number Aadhaar Number PAN CIN GSTIN E-mail Signature or failing him; 2. Full name Address Present Permanent Business Identification Number Aadhaar Number PAN CIN GSTIN E-mail Signature as my proxy to attend and vote for me and on my behalf at the meeting of creditors to be held on [insert date and time of meeting] at [insert venue of the meeting], and at any adjournment thereof in respect of the matters indicated in the notice of the meeting [provide details of the notice], as listed below- [insert matters as listed in the agenda] Signed this [insert date] day of [insert month] [insert year] Signature of creditor Signature of proxy: ”.