Operational Creditors Claim Format Form B with
Declaration for a Company in NCLT
SCHEDULE
FORM B
Proof Of Claim By Operational Creditors Except Workmen And Employees
(Under Regulation 7 of the Insolvency and
Bankruptcy Board of India (Insolvency Resolution Process for Corporate Persons)
Regulations, 2016)
[Date]
To
The Interim Resolution Professional / Resolution
Professional
[Name of the
Insolvency Resolution Professional / Resolution Professional]
[Address as set
out in public announcement]
From
[Name and
address of the operational creditor]
Subject: Submission
of proof of claim.
Madam/Sir,
[Name of the
operational creditor], hereby submits this proof of claim in respect of the
corporate insolvency resolution process in the case of [name of corporate debtor]. The details for the same are set out
below:
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Particulars
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1. |
Name of operational creditor
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2. |
Identification number of
operational 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
operational 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
any dispute as well as the record of pendency or order of suit or arbitration
proceedings |
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7. |
Details of how and when debt
incurred |
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8. |
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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9. |
Details of any retention of
title arrangements in respect of goods or properties to which the claim
refers
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10. |
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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11. |
List of documents attached
to this proof of claim in order to prove the existence and non-payment of
claim due to the operational creditor
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Signature of operational creditor or person
authorised to act on his behalf [Please
enclose the authority if this is being submitted on behalf of an operational
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], 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 in the 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].
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 the claimant)
[Note: In
the case of company or limited liability partnership, the declaration and
verification shall be made by the director/manager/secretary and in the case of
other entities, an officer authorised for the purpose by the entity].
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