[Please state 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.]
Solemnly, affirmed at [insert place] on _________________ day, the __________day of__________ 20_____.
Before me,
Notary/ Oath Commissioner
Deponent's Signature
Verification
I, the Deponent hereinabove, do hereby verify and affirm that the contents of paragraph ___ to __of this affidavit are true and correct to my knowledge and belief and no material facts have been concealed therefrom.
Verified at ______ on this _____ day of ____ 201__.
Deponent's Signature
[Form F] [Inserted by Notification No. IBBI/2017-18/GN/REG 014, dated 16.8.2017 (w.e.f. 14.6.2017)]
Proof of Claims by Creditors (other than financial creditors and operational creditors)
(Under Regulation 9-A of the Insolvency and Bankruptcy Board of India (Fast track Insolvency Resolution Process for Corporate Persons) Regulations, 2017)
[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 creditor]
Subject: Submission of proofs of claim.
Madam/Sir,
I, [name of creditor], hereby submit the following proof of claim in respect of the corporate insolvency resolution process in the case of [name of corporate debtor]. The details of the same are set out below:
Particulars
1.
Name of Creditor
2.
Identification number of the creditor(If an incorporated body corporate, provide identification number and proof of incorporation. If a partnership or individual, provide identification* record of all partner or the individuals)
3.
Address and Email Address of the creditor for correspondence
4.
Description of the claim (Including the amount of the claim as at the insolvency commencement date)
5.
Details of Documents by Reference to which the claim can be substantiated
6.
Details of how and when the claim arose
7.
Details of any mutual credit, mutual debts, or other mutual dealing between the corporate debtor and the creditor which may be set-off against the claim
8.
Details of:a. any security held the value of security and its date, orb. retention title arrangement in respect of goods or properties to which the claim refers
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
10.
List of Documents attached to this proof of claim in order to prove the existence and non-satisfaction of claim due to the creditor
Signature of the creditor or any person authorised to act on his behalf[Please enclose the authority if this is being submitted on behalf of an creditor]
Name in Block Letters
Position with or in relation to the creditor
Address of person signing
* PAN, Passport, Aadhaar or the identity card issued by the Election Commission of India.
Affidavit
I, [name of deponent], currently residing at [insert address], do solemnly affirm and state as follows: