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Form B
[See rule 7(1)] APPLICATION BY CREDITOR TO INITIATE BANKRUPTCY PROCESS [Under rule 7 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019] [Date]…………. To, The Adjudicating Authority [Address] From, [Name and address of the creditor] In the matter of [name of the guarantor] Subject: Application to initiate bankruptcy process in respect of [name of the guarantor] under the Insolvency and Bankruptcy Code, 2016. Madam/Sir, [Name of the creditor], hereby submits this application to initiate a bankruptcy process in the case of [name of guarantor]. The details for the purpose of this application are set out below: Part - I PARTICULARS OF APPLICANT 1. Title and full name 2. Date of birth and e-mail address 3. Contact number(s) Home Mobile Business 4. Identification number of creditor Aadhaar | CIN PAN GSTIN number 5. Address Present Permanent Business Part – II PARTICULARS OF THE GUARANTOR 1. Title and full name 2. Date of birth and e-mail address (to the extent known) 3. Any other name by which the guarantor is or has been known (as applicable) (to the extent known) 4. Address Present Permanent Business 5. Occupation/ Business/ Profession 6. Annual income (to the extent known)
¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 63 7. List of associates of the guarantor, Name Age Address including relatives, who may be creditors (to the extent known) 8. Bank account details (Joint and Several) Account number IFSC code Name of the Bank and Branch address
9. Identification numbers Aadhaar | Passport | PAN GSTIN
number | number 10. Contact number(s) Home Mobile Business 11. List of assets of guarantor as on the Immovable Description Estimated | Excluded
application date (to the extent known) | value | asset or not
Note: this will include all assets of Movable Description Estimated | Excluded debtor, irrespective of them being value | asset or excluded assets. not Vehicles Shares in listed companies Shares in other companies Life insurance policy Jewelry Pension policy Investment in mutual funds Investment in other funds Investment in partnerships and other business concerns, Any other movable property 12. Number of directorships held in the last three years (along with name of company in which directorship is held and Director Identification Number) and CIN of such companies (to the extent known)
13. Marital status (single, married, divorced, widowed, co-habiting, separated, or specify any other) (to the extent known) 14. Details regarding guarantee given by guarantor (in addition to information in serial numbers 1-13 of this part)- Name of corporate debtor for which guarantee is given Any current or past position held in the corporate debtor (to the extent known) Identification number of the corporate debtor Whether corporate debtor is an associate (to the extent known) Any securities held in corporate debtor for whom guarantee is given 15. Where the guarantor is not a resident in India, the name and address of the person authorised to accept the service of process on guarantor’s behalf, along with the authority Part-III PARTICULARS OF DEBT 1. Total debt (including any interest or penalties) 2. Amount in default 3. Date on which debt was due 4. Date on which default occurred 5. Nature of the debt 6. Secured debt including particulars of security held, the date of its creation, its estimated value as per the creditor (as applicable) 7. Unsecured debt (as applicable) 8. Details of retention of title arrangements (if any) in respect of goods to which the debt refers (attach a copy) 9. Details of any mutual credit, mutual debts, or other mutual dealings between the guarantor and the creditor, which may be set-off against the claim (attach proof)
¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 65 10. Particulars of an order of a court, tribunal or arbitral panel adjudicating on the default, if any (attach a copy of the order) 11. Record of default with the information utility, if any (attach a copy) 12. Details of succession certificate, or probate of a will, or letter of administration, or court decree (as may be applicable), under the Indian Succession Act, 1925 (10 of 1925) (attach a copy) 13. Provision of law, contract or other document under which debt has become due (attach a copy) 14. A statement of bank account where deposits are made or credits received normally by the creditor in respect of the debt of the debtor (attach a copy) 15. List of documents attached to this notice in order to prove the existence of debt and the amount in default 16. Statement by the secured creditor under section Tick whichever is applicable- 123(2) of the Code □ In the event a bankruptcy order accepting the application is passed by the Adjudicating Authority, I shall relinquish my security mentioned in serial number 6 for the benefit of all the creditors of the debtor. □ The application is only in respect of unsecured debt as per the details mentioned in serial number 7. 17. Statement by creditor in respect of excluded I [creditor] hereby state that the debt(s) for which debts | the bankruptcy process application is filed does not include any- (i) liability to pay fine imposed by a court or tribunal; (ii) liability to pay damages for negligence, nuisance or breach of a statutory, contractual or other legal obligation; (iii) liability to pay maintenance to any person under any law for the time being in force; (iv) liability in relation to a student loan; (v) any other debt prescribed under section 79(15)(e) of the code.
Part-IV PARTICULARS OF & DECLARATION BY INSOLVENCY PROFESSIONAL (IF PROPOSED TO ACT AS BANKRUPTCY TRUSTEE) 1. Title and full name 2. Address Present Permanent Business 3. E-mail address(es) 4. Contact number Home Mobile Business 5. Declaration by insolvency professional I, [name of insolvency professional], an insolvency professional registered with [name of insolvency professional agency] having registration number [registration number] have been proposed as the insolvency professional by [name of applicant guarantor] in connection with the proposed bankruptcy process of [name of the guarantor]. I hereby: (i) agree to accept appointment as the insolvency professional if an order of appointment is passed by the Adjudicating Authority; (ii) state that the registration number allotted to me by the Board is [insert registration number] and that I am currently qualified to practice as an insolvency professional; (iii) disclose that I am currently serving as an insolvency professional / resolution professional / liquidator/ bankruptcy trustee in [insert number and details of the proceedings]; (iv) certify that there are no disciplinary proceedings pending against me with the Board or [name of the insolvency professional agency he is a member of]; (v) affirm that I am eligible to be appointed as an insolvency professional in respect of the debtor in accordance with regulation 3 of the Insolvency and Bankruptcy Board of India (Bankruptcy Process for Personal Guarantors to Corporate Debtors) Regulations, 2019; (vi) make the following disclosures in accordance with the code of conduct for insolvency professionals as set out in the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [insert disclosures, if any]. (Signature of the insolvency professional)
¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 67 Yours sincerely, Signature of creditor/ person authorised to act on behalf of the creditor [Please enclose the authorisation document if this application is being submitted on behalf of the creditor] Name in block letters Address of person signing List of documents to be attached to the application: 1. All records of the insolvency resolution process in respect of the guarantor, including the following- (i) Application for the insolvency resolution process; (ii) Order(s) of the Adjudicating Authority- (a) accepting / rejecting the application under serial number (i) above, as the case may be; (b) approving / rejecting the repayment plan, as the case may be; (c) entitling the creditor to apply for bankruptcy; (iii) any other order that may have been passed by the Adjudicating Authority in relation to the insolvency resolution process. 2. All documents mentioned in serial number 15 of Part III of this form. 3. Copy of the income tax returns with detailed computation of the income of the guarantor, or the firm, as the case may be, for the previous three years, if available. 4. Copy of the personal guarantee contract. 5. Copy of the authorisation, wherever required under this form. 6. Proof that the application fee has been paid. 7. Documents evidencing the debt and the default in relation to the debt, as may have been provided by the guarantor at any point in time, if available. 8. Documents evidencing the assets, liabilities, income and any other relevant information as may have been provided by the guarantor at any point in time, if available. 9. Documentary evidence of all information sought in each entry for each part of the form.
[See rule 7(1)] APPLICATION BY CREDITOR TO INITIATE BANKRUPTCY PROCESS [Under rule 7 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019] [Date]…………. To, The Adjudicating Authority [Address] From, [Name and address of the creditor] In the matter of [name of the guarantor] Subject: Application to initiate bankruptcy process in respect of [name of the guarantor] under the Insolvency and Bankruptcy Code, 2016. Madam/Sir, [Name of the creditor], hereby submits this application to initiate a bankruptcy process in the case of [name of guarantor]. The details for the purpose of this application are set out below: Part - I PARTICULARS OF APPLICANT 1. Title and full name 2. Date of birth and e-mail address 3. Contact number(s) Home Mobile Business 4. Identification number of creditor Aadhaar | CIN PAN GSTIN number 5. Address Present Permanent Business Part – II PARTICULARS OF THE GUARANTOR 1. Title and full name 2. Date of birth and e-mail address (to the extent known) 3. Any other name by which the guarantor is or has been known (as applicable) (to the extent known) 4. Address Present Permanent Business 5. Occupation/ Business/ Profession 6. Annual income (to the extent known)
¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 63 7. List of associates of the guarantor, Name Age Address including relatives, who may be creditors (to the extent known) 8. Bank account details (Joint and Several) Account number IFSC code Name of the Bank and Branch address
9. Identification numbers Aadhaar | Passport | PAN GSTIN
number | number 10. Contact number(s) Home Mobile Business 11. List of assets of guarantor as on the Immovable Description Estimated | Excluded
application date (to the extent known) | value | asset or not
Note: this will include all assets of Movable Description Estimated | Excluded debtor, irrespective of them being value | asset or excluded assets. not Vehicles Shares in listed companies Shares in other companies Life insurance policy Jewelry Pension policy Investment in mutual funds Investment in other funds Investment in partnerships and other business concerns, Any other movable property 12. Number of directorships held in the last three years (along with name of company in which directorship is held and Director Identification Number) and CIN of such companies (to the extent known)
13. Marital status (single, married, divorced, widowed, co-habiting, separated, or specify any other) (to the extent known) 14. Details regarding guarantee given by guarantor (in addition to information in serial numbers 1-13 of this part)- Name of corporate debtor for which guarantee is given Any current or past position held in the corporate debtor (to the extent known) Identification number of the corporate debtor Whether corporate debtor is an associate (to the extent known) Any securities held in corporate debtor for whom guarantee is given 15. Where the guarantor is not a resident in India, the name and address of the person authorised to accept the service of process on guarantor’s behalf, along with the authority Part-III PARTICULARS OF DEBT 1. Total debt (including any interest or penalties) 2. Amount in default 3. Date on which debt was due 4. Date on which default occurred 5. Nature of the debt 6. Secured debt including particulars of security held, the date of its creation, its estimated value as per the creditor (as applicable) 7. Unsecured debt (as applicable) 8. Details of retention of title arrangements (if any) in respect of goods to which the debt refers (attach a copy) 9. Details of any mutual credit, mutual debts, or other mutual dealings between the guarantor and the creditor, which may be set-off against the claim (attach proof)
¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 65 10. Particulars of an order of a court, tribunal or arbitral panel adjudicating on the default, if any (attach a copy of the order) 11. Record of default with the information utility, if any (attach a copy) 12. Details of succession certificate, or probate of a will, or letter of administration, or court decree (as may be applicable), under the Indian Succession Act, 1925 (10 of 1925) (attach a copy) 13. Provision of law, contract or other document under which debt has become due (attach a copy) 14. A statement of bank account where deposits are made or credits received normally by the creditor in respect of the debt of the debtor (attach a copy) 15. List of documents attached to this notice in order to prove the existence of debt and the amount in default 16. Statement by the secured creditor under section Tick whichever is applicable- 123(2) of the Code □ In the event a bankruptcy order accepting the application is passed by the Adjudicating Authority, I shall relinquish my security mentioned in serial number 6 for the benefit of all the creditors of the debtor. □ The application is only in respect of unsecured debt as per the details mentioned in serial number 7. 17. Statement by creditor in respect of excluded I [creditor] hereby state that the debt(s) for which debts | the bankruptcy process application is filed does not include any- (i) liability to pay fine imposed by a court or tribunal; (ii) liability to pay damages for negligence, nuisance or breach of a statutory, contractual or other legal obligation; (iii) liability to pay maintenance to any person under any law for the time being in force; (iv) liability in relation to a student loan; (v) any other debt prescribed under section 79(15)(e) of the code.
Part-IV PARTICULARS OF & DECLARATION BY INSOLVENCY PROFESSIONAL (IF PROPOSED TO ACT AS BANKRUPTCY TRUSTEE) 1. Title and full name 2. Address Present Permanent Business 3. E-mail address(es) 4. Contact number Home Mobile Business 5. Declaration by insolvency professional I, [name of insolvency professional], an insolvency professional registered with [name of insolvency professional agency] having registration number [registration number] have been proposed as the insolvency professional by [name of applicant guarantor] in connection with the proposed bankruptcy process of [name of the guarantor]. I hereby: (i) agree to accept appointment as the insolvency professional if an order of appointment is passed by the Adjudicating Authority; (ii) state that the registration number allotted to me by the Board is [insert registration number] and that I am currently qualified to practice as an insolvency professional; (iii) disclose that I am currently serving as an insolvency professional / resolution professional / liquidator/ bankruptcy trustee in [insert number and details of the proceedings]; (iv) certify that there are no disciplinary proceedings pending against me with the Board or [name of the insolvency professional agency he is a member of]; (v) affirm that I am eligible to be appointed as an insolvency professional in respect of the debtor in accordance with regulation 3 of the Insolvency and Bankruptcy Board of India (Bankruptcy Process for Personal Guarantors to Corporate Debtors) Regulations, 2019; (vi) make the following disclosures in accordance with the code of conduct for insolvency professionals as set out in the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [insert disclosures, if any]. (Signature of the insolvency professional)
¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 67 Yours sincerely, Signature of creditor/ person authorised to act on behalf of the creditor [Please enclose the authorisation document if this application is being submitted on behalf of the creditor] Name in block letters Address of person signing List of documents to be attached to the application: 1. All records of the insolvency resolution process in respect of the guarantor, including the following- (i) Application for the insolvency resolution process; (ii) Order(s) of the Adjudicating Authority- (a) accepting / rejecting the application under serial number (i) above, as the case may be; (b) approving / rejecting the repayment plan, as the case may be; (c) entitling the creditor to apply for bankruptcy; (iii) any other order that may have been passed by the Adjudicating Authority in relation to the insolvency resolution process. 2. All documents mentioned in serial number 15 of Part III of this form. 3. Copy of the income tax returns with detailed computation of the income of the guarantor, or the firm, as the case may be, for the previous three years, if available. 4. Copy of the personal guarantee contract. 5. Copy of the authorisation, wherever required under this form. 6. Proof that the application fee has been paid. 7. Documents evidencing the debt and the default in relation to the debt, as may have been provided by the guarantor at any point in time, if available. 8. Documents evidencing the assets, liabilities, income and any other relevant information as may have been provided by the guarantor at any point in time, if available. 9. Documentary evidence of all information sought in each entry for each part of the form.