Financial Creditors Claim Format
Form C with Declaration for a Company in NCLT
FORM C
Submission of Claim By
Financial Creditors
(Under Regulation 8 of the Insolvency
and Bankruptcy Board of India (Insolvency Resolution Process for
Corporate Persons) Regulations,
2016)
[Date]
From
[Name and address of the financial creditor, including
address of its registered office and principal office]
To
The Interim Resolution Professional / Resolution
Professional,
[Name of the Insolvency Resolution Professional / Resolution
Professional]
[Address as set out in public announcement]
Subject: Submission
of claim and proof of claim.
Madam/Sir,
[Name of the financial creditor], hereby
submits this claim in respect of the corporate insolvency resolution process of
[name of
corporate debtor]. The details
for the same are set out below:
Relevant
Particulars
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1. |
Name of the financial creditor |
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2. |
Identification number of the financial creditor (If an incorporated body, provide
identification number and proof of incorporation. If a
partnership or individual provide identification records* of all the
partners or the individual) |
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3. |
Address and email address of the financial creditor
for correspondence |
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4. |
Total amount of claim (including any interest as at the
insolvency commencement date) |
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5. |
Details of documents by reference to which the debt
can be substantiated |
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6. |
Details of how and when debt incurred |
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7. |
Details of any mutual credit, mutual debts, or other
mutual dealings between the corporate debtor and the creditor which may be
set-off
against the claim |
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8. |
Details of any security held, the value of the
security, and the date it was given |
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9. |
Details of the bank account to which the amount of
the claim or any part thereof can be transferred pursuant to a resolution
plan |
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10. |
List of documents attached to this claim in order to
prove the existence and non-payment of claim due to the
financial creditor |
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(Signature
of financial creditor or person authorised to act on his behalf) [Please enclose the authority if
this is being submitted on behalf of thefinancial creditor] |
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Name in
BLOCK LETTERS |
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Position
with or in relation to creditor |
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Address of
person signing |
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*PAN number,
passport, AADHAAR Card or the identity card issued by the Election Commission
of India.
DECLARATION
I, [Name
of claimant], currently residing at [insert
address], do hereby declare and state as follows: -
1.
[Name of corporate debtor], the corporate debtor was, at the insolvency commencement
date, being the……………..day of…………..20……., actually indebted to me for a sum of Rs. [insert amount of claim].
2.
In respect of my claim of the said
sum or any part thereof, I have relied on the documents specified below: [Please list the documents relied on as evidence of claim].
3.
The said documents are true, valid
and genuine to the best of my knowledge, information and belief and no material
facts have been concealed therefrom.
4.
In respect of the said sum or any
part thereof, neither I, nor any person, by my order, to my knowledge or
belief, for my use, had or received any manner of satisfaction or security
whatsoever, save and except the following:
[Please state details of any mutual credit, mutual debts, or
other mutual dealings between the corporate debtorand the creditor which may be
set-off against the claim].
5.
I am / I
am not a related party of the corporate debtor, as defined under section 5 (24) of the Code.
- I am eligible to join committee of creditors by virtue
of proviso to section 21 (2) of the Code even though I am a related party of the
corporate debtor.
Date:
Place:
(Signature
of the claimant)
VERIFICATION
I, [Name] the claimant hereinabove, do hereby
verify that the contents of this proof of claim are true and correct to my
knowledge and belief and no material fact has been concealed therefrom.
Verified at … on this …… day of ……….,
20…
(Signature of claimant)
[Note: In the case of company or limited liability partnership, the declaration and verification shall be made by the director/manager/secretary/designated partner and in the case of other entities, an officer authorised for the purpose by the entity.]
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