Form -5
(See sub- rule (1) of rule 6)
Application by Operational
Creditor to Initiate Corporate Insolvency Resolution Process under the Insolvency and Bankruptcy Code, 2016
(Under
rule 6 of the Insolvency and Bankruptcy (Application to Adjudicating Authority
) Rules, 2016
Date
To,
The
National Company Law Tirbunal
[Address]
From,
[Name
and address for correspondence of the operational creditor]
In
the matter of [ name of the corporate debtor]
Subject
: Application to initiate corporate resolution process in respect of [ name of
the corporate debtor] under the Insolvency and Bankruptcy Code, 2016.
Madam/Sir,
[Name
of the operational creditor], hereby submits this application to initiate a
corporate insolvency resolution process in the case of [ name of
corporate debtor]. The details for the purpose of this application
are set out below:
Part- I
Particulars of Applicant
1. Name
of operational creditor
2. Identification
number of operational creditor (if any)
3. Address
for correspondence of the operational creditor
Part – II
Particulars of 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 the corporate debtor
And
/or details of guarantee clause as per Memorandum of association (as
Applicable)
5. Address of the registered
office of the Corporate Debtor
6. Name, address and
authority of person submitting application
On
behalf of Operational creditor (Enclose authorization)
7. Name and address of person
resident in India authorized to accept the service
Of
process on its behalf ( Enclose authorization)
Part- III
Particulars of the Proposed
Interim Resolution Professional [if Proposed]
1. Name,
address, email address and the Registration number of the proposed Insolvency
professional
Part – IV
Particulars of Operational Debt
1. Total
Amount of debt , details of transactions on account of which
Debt
fell due, and the date from which such fell due
2. Amount
claimed to be default and the date on which the default
Occurred
( Attach the workings for computation of amount
And
dates of default in tabular form)
Part – V
Particulars of Operational Debt
[Documents, Records and Evidence of Default]
1. Particulars
of security held, if any, the date of its creation , its estimated value as per
the creditor.
Attach
a copy of a certificate of registration of charge issued by the registrar of
companies (If the corporate debtor is a company)
2. Details
of reservation / Retention of title arrangements (if any) in respect of goods
to which the operational debt refers
3. Particulars
of an order of a court, tribunal or arbitral panel adjudicating on the default,
if any (attach a copy of the order)
4. Record
of default with the information utility, if any (attach a copy of such record)
5. Details
of succession certificate, or Probate of a will , or letter of administration
or court decree ( as may be applicable), under the Indian succession act, 1925
(10 of 1925) (attach a copy)
6. Provision
of law , contract or other document under which operational debt has become
due.
7. A
statement of bank account where deposit are made or credits received normally
by the operational creditor in respect of the debt of the corporate debtor (
attach copy)
8. List
of other documents attached to this application in order to prove the existence
of operational debt and the amount in default.
I,[Name
of the operational creditor/person authorized to act on behalf of the
operational creditor] hereby certify that, to the best of my knowledge , [ name
of proposed insolvency professional ], is fully qualified and permitted to act
as an insolvency professional in accordance with the code and the rules and
regulations made thereunder. [WHERE APPLICABLE]
[Name
of the operational creditor] has paid the requisite fee for this application
through [ state means o payment] on [date]
Yours
Sincerely,
Signature
of person authorized to act on behalf of the operational creditor
Name
in block letters
Position
with or in relation to the operational creditor
Address
of person signing
Instructions
Please
attached the following to this application:
Annex
I Copy of the invoice / Demand notice
as in Form 3 of the Insolvency and
Bankruptcy
(application to Adjudicating Authority) Rules, 2016 served on the
corporate
debtor.
Annex
II Copies of all documents referred to in
this application
Annex III Copy
of the relevant accounts from the bank/financial institutions maintaining
accounts
of the operational creditor confirming that there is no payment of the
relevant
unpaid operational debt by the operational debtor, if available.
Annex IV Affidavit
in support of the application in accordance with the Insolvency and
Bankruptcy
( Application to Adjudicating Authority) Rules2016.
Annex V Written
communication by the proposed resolution professional as set out in
Form
2 of the Insolvency and Bankruptcy ( Application to Adjudicating Authority
)
Rules 2016. [ WHERE APPLICABLE].
Annex
VI Proof that the specified application fee has
been paid.
Note: Where
workmen Employees are operational creditors, the application may be made either
in an individual capacity or in a joint capacity by one of them who is duly
authorized for the purpose.
