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[Section 10]
[Entire Act]
Union of India - Subsection
Section 10(4) in The Insolvency and Bankruptcy (Application to Adjudicating Authority) Rules, 2016
| Particulars ofApplicant (Please Provide for each Financial Creditor making theApplication) | ||
| 1. | Name of financial creditor | |
| 2. | Date of incorporation of financial creditor | |
| 3. | Identification number of financial creditor | |
| 4. | Address of the registered office of the financial creditor | |
| 5. | Name and address of the person authorized to submitapplication on its behalf(Enclose Authorization) | |
| 6. | Name and address of person resident in India authorized toaccept the service of process on its behalf(EncloseAuthorization) |
| Particulars of the Corporate Debtor | ||
| 1. | Name of the corporate debtor | |
| 2. | Identification number of corporate debtor | |
| 3. | Date of incorporation of corporate debtor | |
| 4. | Nominal share capital and the paid-up share capital of thecorporate debtor and/or details of guarantee clause as permemorandum of association (as applicable) | |
| 5. | Address of the registered office of the corporate debtor | |
| 6. [ [Inserted by Notification No. G.S.R. 222(E), dated 14.3.2019 (w.e.f. 30.11.2016).] | Details of The Corporate Debtor As Per The Notification Under Section 55 (2) of The Code (i) Assets And Income(ii) Class of Creditors or Amount of Debt(iii) Category of Corporate Person(Where Application Is Under Chapter IV of Part II of The Code)]; |
| Particulars of the Proposed interim ResolutionProfessional | ||
| 1. | Name, address, email address and the registration number ofthe proposed interim resolution professional |
| Particulars of Financial Debt | ||
| 1. | Total amount of debt granted date(s) of disbursement | |
| 2. | Amount claimed to be in default and the date on which thedefault occurred(Attach the workings for computation ofamount and days of default in tabular form) |
| Particulars of Financial Debt [Documents,Records and Evidence of Default] | |
| 1. | Particulars of security held, if any, the date of itscreation, its estimated value as per the creditor.Attach acopy of a certificate of registration of charge issued by theregistrar of companies (if the corporate debtor is a company) |
| 2. | Particulars of an order of a court, tribunal or arbitral paneladjudicating on the default, if any(Attach a copy of theorder) |
| 3. | Record of default with the information utility, if any(Attacha copy of such record) |
| 4. | Details of succession certificate, or probate of a will, orletter of administration, or courtDecree (as may beapplicable), under the Indian succession act, 1925 (10 of1925)(Attach a copy) |
| 5. | The latest and complete copy of the financial contractreflecting all amendments and waivers To Date(Attach a Copy) |
| 6. | A Record of default as available with any credit informationcompany(Attach a copy) |
| 7. | Copies of entries in a bankers book in accordance with thebankers books evidence act, 1891 (18 of 1891)(Attach a Copy) |
| 8. | List of other documents attached to this application in orderto prove the existence of financial debt, the amount and date ofdefault |
| Signature of person authorized to act on behalf of thefinancial creditor |
| Name in block letters |
| Position with or in relation to the financial creditor |
| Address of person signing |
| Annex I | Copies of all documents referred to in this application. |
| Annex II | Written communication by the proposed interim resolutionprofessional as set out in Form 2. |
| Annex III | Proof that the specified application fee has been paid. |
| Annex IV | Where the application is made jointly, the particularsspecified in this form shall be furnished in respect of all thejoint applicants along with a copy of authorization to thefinancial creditor to file and act on this application on behalfof all the applicants. |