Form E

[See rule 11] STATEMENT OF FINANCIAL POSITION OF BANKRUPT [Under rule 11 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy

Process for Personal Guarantors to Corporate Debtors) Rules, 2019] Part I RELEVANT PARTICULARS 1. Full name of bankrupt

2. Address Present Permanent Business

3. Bank account details

(Joint and Several) Account Number IFSC Code Name of Bank

and Bank Branch

¹Hkkx IIμ[k.M 3(i)] Hkkjr dk jkti=k % vlk/kj.k 69 4. List of assets of bankrupt

and immediate family as on the application date for the previous three years. Note: this will include all

assets of bankrupt,

irrespective of them being excluded assets. Please

mention the assets which

may be excluded assets. Immovable property Description Estimated

value Excluded asset or not Movable property Description Estimated

value Excluded asset or not Vehicles Shares in listed companies Shares in other companies Life insurance policy Jewellery Pension policy Investment in mutual funds Investment in other funds Investment in partnerships and other business concerns Any other property not covered above 5. The following information is required in relation to the guarantee given by the guarantor:

i. Name of corporate debtor

for which guarantee is

given ii. Any current or past

position held in the corporate debtor iii. Whether corporate debtor

is an associate iv. Any securities held in

corporate debtor for whom guarantee is given

6. Name and address of

person resident in India authorised to accept the service of process on

bankrupt’s behalf (if

applicable) Part II

FINANCIAL INFORMATION 1. Statement of assets and liabilities for the previous

three years 2. Secured and unsecured debts, with complete

details of the creditors including name and postal address, the total amount due, amount in default and details of the security, for the previous three years 3. Details of the debts owed to associates of the

bankrupt, for the previous three years 4. Details of guarantees given in relation to any of

the debts of the guarantor, and if any of the guarantors is an associate of the guarantor 5. Details of the business owned by the bankrupt, or

of the firm in which the bankrupt is a partner, as the case may be, for the previous three years, if applicable 6. Details of the wealth tax statements filed by the

bankrupt, if any, for the previous five years. 7. Details of trusts held by bankrupt and/or

immediate family of bankrupt 8. Any other relevant information