Schedule II-Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016

PROFORMA FOR REPORTING CONSULTATIONS WITH STAKEHOLDERS

(Under Regulation 8 and Regulation 31A of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

Sl. No.	Basic details of CD and meeting
(a)	Name and Registration no. of Liquidator
(b)	Name of corporate debtor
(c)	Date of the meeting
(d)	Date of last meeting
(e)	Number of days since last meeting
(f)	Details of agenda of last meeting which were not approved by the SCC
-	Details of agenda items	Para of the minutes of the meeting where the same was discussed	Remarks
(a)	Remuneration of professionals appointed under regulation 7, including process advisors, IPE, etc.
(b)	Sale under regulation 32, including manner of sale, pre-bid qualifications, reserve price, marketing strategy and auction process
(c)	Fees of the liquidator
(d)	Valuation under sub-regulation (2) of regulation 35
(e)	Status of Litigations and cost benefit analysis of pursuing these litigations
(f)	Preliminary report
(g)	Manner in whichproceedings in respect of preferential transactions, undervalued transaction, extortionate credit transaction or fraudulent or wrongful trading, if any, shall be pursued after closure of liquidation proceedings and the manner in which the proceeds, if any, from these proceedings shall be distributed
(h)	Liquidation cost
(i)	Extension of time period for payment of balance sale consideration beyond ninety days
(j)	Running the business of the corporate debtor in the event the same is economically unviable
(k)	Early dissolution of the corporate debtor
(l)	Any other agenda item

FORM A

PROFORMA FOR REPORTING CONSULTATIONS WITH STAKEHOLDERS

(Under Regulation 8 of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

Separate proforma to be used for each stakeholder or group of homogenous stakeholders

NAME AND REGISTRATION NO. OF LIQUIDATOR:
NAME OF CORPORATE DEBTOR BEING LIQUIDATED:
LIQUIDATION CASE NO:
NAME OF THE STAKEHOLDER: DATE OF CONSULTATION (IF HELD IN PERSON): NUMBER AND DATES OF COMMUNICATIONS RECEIVED FROM STAKEHOLDER: SUMMARY OF CONSULTATION:

WRITTEN CONSENT TO ACT AS LIQUIDATOR

(Under regulation 31A of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

[Date]

From
[Name of the insolvency professional]
[Registration number of the insolvency professional
[Address of the insolvency professional registered with the Board]

To
The Stakeholders’ Consultation Committee
[name of corporate debtor]

Subject: Written Consent to act as liquidator.

I, [name], an insolvency professional enrolled with [name of insolvency professional agency] and registered with the Board, note that the consultation committee proposes to appoint me as liquidator under regulation 31A of Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016 for conducting liquidation process of [name of the corporate debtor].

2. In accordance with aforementioned regulation, I hereby give consent to the proposed appointment.

3. I declare and affirm as under: –

a. I am registered with the Board as an insolvency professional.

b. I am not subject to any disciplinary proceedings initiated by the Board or the Insolvency Professional Agency.

c. I do not suffer from any disability to act as a liquidator.

d. I am eligible to be appointed as liquidator of the corporate debtor under regulation 3 and other applicable provisions of the Code and regulations.

e. I shall make the disclosures in accordance with the code of conduct for insolvency professionals as set out in the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016;

f. I am having the following processes in hand:

Sl. No.	Role as	No .of Processes on the date of Consent
1	Interim Resolution Professional
2	Resolution Professional of a. Corporate Debtors b Individuals
3	Liquidator of a. Liquidation Processes b. Voluntary Liquidation Processes
4	Bankruptcy Trustee
5	Authorised Representative
6	Any other (Please state)

(Signature of the insolvency professional)

Registration No. …….

Date:

Place:

PUBLIC ANNOUNCEMENT
(Regulation 12 of the Insolvency and Bankruptcy Board of India (Liquidation Process)
Regulations, 2016)

FOR THE ATTENTION OF THE STAKEHOLDERS OF [Name of Corporate Debtor]

Sl. No.	PARTICULARS	DETAILS
1.	Name of corporate debtor
2.	Date of incorporation of corporate debtor
3.	Authority under which corporate debtor is incorporated / registered
4.	Corporate Identity No. / Limited Liability Identification No. of corporate debtor
5.	Address of the registered office and principal office (if any) of corporate debtor
6.	Date of closure of Insolvency Resolution Process
7.	Liquidation commencement date of corporate debtor
8.	Name and registration number of the insolvency professional acting as liquidator
9.	Address and e-mail of the liquidator, as registered with the Board
10.	Address and e-mail to be used for correspondence with the liquidator
11.	Last date for submission of claims

Notice is hereby given that the National Company Law Tribunal (Name of Bench) has ordered the commencement of liquidation of the [Name of the corporate debtor] on [date of passing of order of liquidation under section 33 of the Code].

The stakeholders of [—–Name of the corporate debtor] are hereby called upon to submit  their claims with proof on or before ——-[Insert the date falling thirty days after the liquidation commencement date] [ ], to the liquidator at the address mentioned against item No. 10.

The financial creditors shall submit their claims with proof by electronic means only. All other creditors may submit the claims with the proof in person, by post or by electronic means.

Submission of false or misleading proof of claims shall attract penalties.

Name and signature of liquidator :
Date and place :

FORM B

PUBLIC ANNOUNCEMENT

(Regulation 12 of the Insolvency and Bankruptcy (Liquidation Process) Regulations, 2016)

FOR THE ATTENTION OF THE STAKEHOLDERS OF [Name of Corporate Debtor]

1	NAME OF CORPORATE DEBTOR
2	DATE OF INCORPORATION OF CORPORATE DEBTOR
3	AUTHORITY UNDER WHICH CORPORATE DEBTOR IS INCORPORATED/ REGISTERED
4	CORPORATE IDENTITY NUMBER / LIMITED LIABILITY IDENTITY NUMBER OF CORPORATE DEBTOR
5	ADDRESS OF THE REGISTERED OFFICE AND PRINCIPAL OFFICE (IF ANY) OF CORPORATE DEBTOR
6	DATE OF CLOSURE OF INSOLVENCY RESOLUTION PROCESS
7	LIQUIDATION COMMENCEMENT DATE OF CORPORATE DEBTOR
8	NAME, ADDRESS, EMAIL ADDRESS, TELEPHONE NUMBER AND THE REGISTRATION NUMBER OF THE LIQUIDATOR
9	LAST DATE FOR SUBMISSION OF CLAIMS

FORM C

PROOF OF CLAIM BY OPERATIONAL CREDITORS EXCEPT WORKMEN AND EMPLOYEES

(Under Regulation 17 of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

[Date]

To

The Liquidator

[Name of the Liquidator]

[Address as set out in the public announcement]

From

[Name and address of the operational creditor]

Subject: Submission of proof of claim in respect of the liquidation of [name of corporate debtor] under the Insolvency and Bankruptcy Code, 2016.

Madam/Sir,

[Name of the operational creditor] hereby submits this proof of claim in respect of the liquidation of [name of corporate debtor].

The details for the same are set out below:

1	NAME 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)
2	ADDRESS OF OPERATIONAL CREDITOR FOR CORRESPONDENCE
3	TOTAL AMOUNT OF CLAIM, INCLUDING ANY INTEREST, AS AT LIQUIDATION COMMENCEMENT DATE AND DETAILS OF NATURE OF CLAIM	PRINCIPAL : INTEREST : TOTAL CLAIM :
4	DETAILS OF DOCUMENTS BY REFERENCE TO WHICH THE DEBT CAN BE SUBSTANTIATED
5	DETAILS OF ANY DISPUTE AS WELL AS THE RECORD OF PENDENCY OF SUIT OR ARBITRATION PROCEEDINGS
6	DETAILS OF HOW AND WHEN DEBT INCURRED
7	DETAILS OF ANY MUTUAL CREDIT, MUTUAL DEBTS, OR OTHER MUTUAL DEALINGS BETWEEN THE CORPORATE DEBTOR AND THE OPERATIONAL CREDITOR WHICH MAY BE SET-OFF AGAINST THE CLAIM
8	DETAILS OF ANY RETENTION OF TITLE IN RESPECT OF GOODS OR PROPERTIES TO WHICH THE DEBT REFERS OR ANY OTHER SECURITY
8A Inserted vide IBBI (Liquidation Process) (Amendment) Regulations, 2019 dated 25.07.2019	WHETHER SECURITY INTEREST RELINQUISHED	Yes/ No
9	DETAILS OF ANY ASSIGNMENT OR TRANSFER OF DEBT IN HIS FAVOUR
10	DETAILS OF THE BANK ACCOUNT TO WHICH THE OPERATIONAL CREDITOR’S SHARE OF THE PROCEEDS OF LIQUIDATION CAN BE TRANSFERRED
11	LIST OUT AND ATTACH THE DOCUMENTS RELIED ON IN SUPPORT OF THE CLAIM.	(i) (ii) (iii)

Signature of operational creditor or person authorised to act on his behalf

(Please enclose the authority if this is being submitted on behalf of the operational creditor)

Name in BLOCK LETTERS

Position with or in relation to creditor

Address of person signing

*PAN, Passport, AADHAAR Card or the identity card issued by the Election Commission of India.

AFFIDAVIT

I, [name of deponent], currently residing at [address of deponent], do solemnly affirm and state as follows:

1. The above named corporate debtor was, at liquidation commencement date, that is, the __________ day of __________ 20______ and still is, justly and truly indebted to me [or to me and[insert name of copartners], my co-partners in trade, or, as the case may be] in the sum of Rs. __________ for _____ [please state consideration].

2. In respect of my claim of the said sum or any part thereof, I have relied on and the documents specified below:

[Please list the documents relied on as evidence of debt.]

3. The said documents are true, valid and genuine to the best of my knowledge, information and belief.

4. In respect of the said sum or any part thereof, I have not, nor have my partners or any of them, nor has any person, by my/our order, to my/our knowledge or belief, for my/ our 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 debtor and the operational creditor which may be set-off against the claim.]

Solemnly, affirmed at _____________________ 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 para ___ to __of this affidavit are true and correct to my knowledge and belief. Nothing is false and nothing material has been concealed therefrom.

Verified at ________ on this ________ day of ________ 201_____

Deponent’s signature

FORM D

PROOF OF CLAIM BY FINANCIAL CREDITORS

(Under Regulation 18 of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

[Date]

To

The Liquidator

[Name of the Liquidator]

[Address as set out in the public announcement]

From

[Name and address of the registered office and principal office of the financial creditor]

Subject: Submission of proof of claim in respect of the liquidation of [name of corporate debtor] under the Insolvency and Bankruptcy Code, 2016.

Madam/Sir,

[Name of the financial creditor] hereby submits this proof of claim in respect of the liquidation of [name of corporate debtor]. The details for the same are set out below:

1	NAME OF 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)
2	ADDRESS AND EMAIL OF FINANCIAL CREDITOR FOR CORRESPONDENCE.
3	TOTAL AMOUNT OF CLAIM, INCLUDING ANY INTEREST, AS AT THE LIQUIDATION COMMENCEMENT DATE AND DETAILS OF NATURE OF CLAIM (WHETHER TERM LOAN, SECURED, UNSECURED)	PRINCIPAL : INTEREST : TOTAL CLAIM :
4	DETAILS OF DOCUMENTS BY REFERENCE TO WHICH THE DEBT CAN BE SUBSTANTIATED
5	DETAILS OF ANY ORDER OF A COURT OF TRIBUNAL THAT HAS ADJUDICATED ON THE NON-PAYMENT OF DEBT
6	DETAILS OF HOW AND WHEN DEBT INCURRED
7	DETAILS OF ANY MUTUAL CREDIT, MUTUAL DEBTS, OR OTHER MUTUAL DEALINGS BETWEEN THE CORPORATE DEBTOR AND THE FINANCIAL CREDITOR WHICH MAY BE SET-OFF AGAINST THE CLAIM
8	DETAILS OF ANY SECURITY HELD, THE VALUE OF THE SECURITY, AND THE DATE IT WAS GIVEN
8A Inserted vide IBBI (Liquidation Process) (Amendment) Regulations, 2019 dated 25.07.2019	WHETHER SECURITY INTEREST RELINQUISHED	Yes/ No
9	DETAILS OF ANY ASSIGNMENT OR TRANSFER OF DEBT IN HIS FAVOUR
10	DETAILS OF THE BANK ACCOUNT TO WHICH THE FINANCIAL CREDITOR’S SHARE OF THE PROCEEDS OF LIQUIDATION CAN BE TRANSFERRED
11	LIST OUT AND ATTACH THE DOCUMENTS RELIED ON IN SUPPORT OF THE CLAIM.	(i) (ii) (iii)

Signature of financial creditor or person authorised to act on his behalf

(please enclose the authority if this is being submitted on behalf a financial creditor)

Name in BLOCK LETTERS

Position with or in relation to creditor

Address of person signing

*PAN, Passport, AADHAAR Card or the identity card issued by the Election Commission of India.

AFFIDAVIT

I, [name of deponent], currently residing at [address of deponent], do solemnly affirm and state as follows:

1. The above named corporate debtor was, at the liquidation commencement date, that is, the __________ day of __________ 20____ and still is, justly and truly indebted to me [or to me and [insert name of copartners], my co-partners in trade, or, as the case may be] in the sum of Rs. __________ for ……..[please state consideration].

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 debt and of non-payment.]

3. The said documents are true, valid and genuine to the best of my knowledge, information and belief.

4. In respect of the said sum or any part thereof, I have not, nor have my partners or any of them, nor has any person, by my/our order, to my/our knowledge or belief, for my/ our 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 debtor and the financial creditor which may be set-off against the claim.]

Solemnly, affirmed at _____________________ 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 para ___ to __of this affidavit are true and correct to my knowledge and belief. Nothing is false and nothing material has been concealed therefrom.

Verified at ________ on this ________ day of ________ 201___.

Deponent’s signature.

FORM E

PROOF OF CLAIM BY A WORKMAN OR EMPLOYEE

(Under Regulation 19 of the Insolvency and Bankruptcy (Liquidation Process) Regulations, 2016)

[Date]

To

The Liquidator

[Name of the Liquidator]

[Address as set out in public announcement]

From

[Name and address of the workman / employee]

Subject: Submission of proof of claim in respect of liquidation of (Name of corporate debtor) under the Insolvency and Bankruptcy Code, 2016.

Madam/Sir,

[Name of the workman / employee], hereby submits this proof of claim in respect of the liquidation of [name of corporate debtor]. The details for the same are set out below:

1	NAME OF WORKMAN/EMPLOYEE
2	PAN, PASSPORT, THE IDENTITY CARD ISSUED BY THE ELECTION COMMISSION OF INDIA OR AADHAAR CARD OF WORKMAN / EMPLOYEE
3	ADDRESS AND EMAIL ADDRESS (IF ANY) OF WORKMAN / EMPLOYEE FOR CORRESPONDENCE
4	TOTAL AMOUNT OF CLAIM (INCLUDING ANY INTEREST AS AT THE LIQUIDATION COMMENCEMENT DATE)
5	DETAILS OF DOCUMENTS BY REFERENCE TO WHICH THE DEBT CAN BE SUBSTANTIATED.
6	DETAILS OF ANY DISPUTE AS WELL AS THE RECORD OF PENDENCY OR ORDER OF SUIT OR ARBITRATION PROCEEDINGS
7	DETAILS OF HOW AND WHEN CLAIM AROSE
8	DETAILS OF ANY MUTUAL CREDIT, MUTUAL DEBTS, OR OTHER MUTUAL DEALINGS BETWEEN THE CORPORATE DEBTOR AND THE WORKMAN / EMPLOYEE WHICH MAY BE SET-OFF AGAINST THE CLAIM
9	DETAILS OF THE BANK ACCOUNT TO WHICH THE WORKMAN / EMPLOYEE’S SHARE OF THE PROCEEDS OF LIQUIDATION CAN BE TRANSFERRED
10	LIST OUT AND ATTACH THE DOCUMENTS RELIED ON IN SUPPORT OF THE CLAIM.	(i) (ii) (iii)

Signature of workman / employee or person authorised to act on his behalf

[Please enclose the authority if this is being submitted on behalf of an operational creditor]

Name in BLOCK LETTERS

Position with or in relation to creditor

Address of person signing

AFFIDAVIT

I, [name of deponent], currently residing at [insert address], do solemnly affirm and state as follows:

5. [Name of corporate debtor], the corporate debtor was, at the liquidation commencement date, that is, the __________ day of __________ 20__, justly and truly indebted to me in the sum of Rs. [insert amount of claim].

6. 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]

7. The said documents are true, valid and genuine to the best of my knowledge, information and belief.

8. In respect of the said sum or any part thereof, I have not nor has 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 debtor and the workman / employee 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

PROOF OF CLAIM BY AUTHORISED REPRESENTATIVE OF WORKMEN OR EMPLOYEES

(Under Regulation 19 of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

[Date]

To

The Liquidator

[Name of the Liquidator]

[Address as set out in the public announcement]

From

[Name and address of the authorised representative of workmen/ employees]

Subject: Submission of proof of claim in respect of the liquidation of [name of corporate debtor] under the Insolvency and Bankruptcy Code, 2016.

Madam/Sir,

I, [name of duly authorised representative of the workmen/ employees] currently residing at [address of duly authorised representative of the workmen/ employees], on behalf of the workmen and employees employed by the above named corporate debtor, solemnly affirm and say:

1. That the abovenamed corporate debtor was, on the liquidation commencement date, that is, the ________ day of ______ 20 ___ and still is, justly truly indebted to the several persons whose names, addresses, and descriptions appear in the Annexure below in amounts severally set against their names in such Annexure for wages, remuneration and other amounts due to them respectively as workmen or/ and employees in the employ of the corporate debtor in respect of services rendered by them respectively to the corporate debtor during such periods as are set out against their respective names in the said Annexure.

2. That for which said sums or any part thereof, they have not, nor has any of them, had or received any manner of satisfaction or security whatsoever, save and except the following:

[Please state details of any mutual credits, mutual debts, or other mutual dealings between the corporate debtor and the workmen / employees which may be set-off against the claim.]

Signature :

ANNEXURE

1. Details of Employees/ Workmen

S NO.	NAME OF EMPLOYEE/ WORKMEN	IDENTIFICATION NUMBER (PAN/, PASSPORT NUMBER/, AADHAAR NO. / ID CARD ISSUED BY THE ELECTION COMMISSION AND EMPLOYEE ID NO., IF ANY	TOTAL AMOUNT DUE AND DETAILS ON NATURE OF CLAIM	PERIOD OVER WHICH AMOUNT DUE	DETAILS OF EVIDENCE OF DEBT INCLUDING EMPLOYMENT CONTRACTS AND OTHER PROOFS
1
2
3
4
5

2. Particulars of how dues were incurred by the corporate debtor, including particulars of any dispute as well as the record of pendency of suit or arbitration proceedings.

3. Particulars of any mutual credit, mutual debts, or other mutual dealings between the corporate debtor and the workmen / employee which may be set-off against the claim.

4. Please list out and attach the documents relied on to prove the claim.

AFFIDAVIT

I, [insert full name, address and occupation of deponent] do solemnly affirm and state as follows:

1. The above named corporate debtor was, at the liquidation commencement date that is, the __________ day of __________ 20__ and still is, justly and truly indebted to the workmen and employees in the sum of Rs. __________ for _____ [please state the nature and duration of employment].

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 proof]

3. The said documents are true, valid and genuine to the best of my knowledge, information and belief.

4. In respect of the said sum or any part thereof, the workmen / employees have not, nor has any person, by my order, to my knowledge or belief, for my use, had or has 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 debtor and the workmen / employees which may be set-off against the claim.]

Solemnly, affirmed at _____________________ 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 para ___ to __of this affidavit are true and correct to my knowledge and belief. Nothing is false and nothing material has been concealed therefrom.

Verified at _______ on this _______ day of _______ 201___

Deponent’s signature

FORM G

PROOF OF CLAIM BY ANY OTHER STAKEHOLDER

(Under Regulation 20 of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016)

[Date]

To

The Liquidator

[Name of the Liquidator]

[Address as set out in the public announcement]

From

[Name and address of the other stakeholder]

Subject: Submission of proof of claim in respect of the liquidation of [name of corporate debtor] under the Insolvency and Bankruptcy Code, 2016.

Madam/Sir,

[Name of the other stakeholder] hereby submits this proof of claim in respect of the liquidation in the case of [name of corporate debtor]. The details for the same are set out below:

1	NAME OF OTHER STAKEHOLDER (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)
2	ADDRESS AND EMAIL OF THE OTHER STAKEHOLDER FOR CORRESPONDENCE.
3	TOTAL AMOUNT OF CLAIM, INCLUDING ANY INTEREST AS AT LIQUIDATION COMMENCEMENT AND DETAILS OF NATURE OF CLAIM	PRINCIPAL CLAIM : INTEREST : TOTAL CLAIM :
4	DETAILS OF DOCUMENTS BY REFERENCE TO WHICH THE CLAIM CAN BE SUBSTANTIATED
5	DETAILS OF HOW AND WHEN CLAIM AROSE
6	DETAILS OF ANY MUTUAL CREDIT, MUTUAL DEBTS, OR OTHER MUTUAL DEALINGS BETWEEN THE CORPORATE DEBTOR AND THE OTHER STAKEHOLDER WHICH MAY BE SET-OFF AGAINST THE CLAIM
7	DETAILS OF ANY RETENTION OF TITLE IN RESPECT OF GOODS OR PROPERTIES TO WHICH THE CLAIM REFERS
8	DETAILS OF ANY ASSIGNMENT OR TRANSFER OF DEBT IN HIS FAVOUR
9	DETAILS OF THE BANK ACCOUNT TO WHICH THE OTHER STAKEHOLDER’S SHARE OF THE PROCEEDS OF LIQUIDATION CAN BE TRANSFERRED
10	LIST OUT AND ATTACH THE DOCUMENTS RELIED ON IN SUPPORT OF THE CLAIM.	(i) (ii) (iii)

Signature of other stakeholder or person authorised to act on his behalf

(Please enclose the authority if this is being submitted on behalf of the other stakeholder)

Name in BLOCK LETTERS

Position with or in relation to creditor

Address of person signing

*PAN, Passport, AADHAAR Card or the identity card issued by the Election Commission of India.

AFFIDAVIT

I, [insert full name, address and occupation of deponent to be given] do solemnly affirm and state as follows:

1. The above named corporate debtor was, at the liquidation commencement date, that is, the __________ day of __________ 20__ and still is, justly and truly indebted to me [or to me and [insert name of copartner], my co-partners in trade, or, as the case may be,] in the sum of Rs. __________ for _____ [please state consideration].

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 proof.]

3. The said documents are true, valid and genuine to the best of my knowledge, information and belief.

4. In respect of the said sum or any part thereof, I have not, nor have my partners or any of them, nor has any person, by my/our order, to my/our knowledge or belief, for my/ our 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 debtor and the other stakeholder which may be set-off against the claim.]

Solemnly, affirmed at _____________________ 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 para ___ to __of this affidavit are true and correct to my knowledge and belief. Nothing is false and nothing material has been concealed therefrom.

Verified at ______ on this ______ day of ______ 201__

Deponent’s signature.

COMPLIANCE CERTIFICATE

[Under Regulation 45(3) of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016]

I, [Name of the Liquidator], an insolvency professional enrolled with [name of insolvency professional agency] and registered with the Board with registration number [registration number], am the Liquidator for the Liquidation Process of [name of the corporate debtor (CD)].
2. The details of the Liquidation Process are as under:

SI. No.	Particulars	Description
(1)	(2)	(3)
1	Name of the corporate debtor
2	Case No. & NCLT Bench
3	Date of initiation of liquidation
4	Date of appointment of liquidator
5	Date of commencement of CIRP
6	Name of RP during CIRP and his registration No. as IP
7	Name of Liquidator and his registration No. as IP
8	Date of Publication of Public Announcement under Form B
9	Date of Intimation to Registry and Information Utility, if any, about commencement of Liquidation
10	Date of handover of charge by RP
11	Date of submission of compliance, if any, directed by AA in the liquidation order and its particulars
12	Date of appointment of registered valuers, if any
13	Date of notice for uncalled capital/unpaid capital contribution
14	Date of realisation of uncalled capital/unpaid capital contribution
15	Date of realisation of uncalled capital/unpaid capital contribution
16	Date of constitution of Consultation Committee
17	No. of meetings of consultation committee held
18	Date of submission of list of stakeholders to AA
19 (Omitted vide IBBI (Liquidation Process) (Second Amendment) Regulations, 2021 dated 30.09.2021)	Date of public announcement of list of stakeholders (Omitted vide IBBI (Liquidation Process) (Second Amendment) Regulations, 2021 dated 30.09.2021)
20	Date of filing of preliminary report & assets memorandum to AA
21	Fair value
22	Liquidation value
23	Date of public notice announcement (Substituted vide IBBI (Liquidation Process) (Second Amendment) Regulations, 2021 dated 30.09.2021) for auction (please add additional rows, if required)
24	Date of order of AA to dispense with the public noticeannouncement (Substituted vide IBBI (Liquidation Process) (Second Amendment) Regulations, 2021 dated 30.09.2021) for Auction
25	Date of permission of AA for physical Auction
26	Date of permission of AA for private sale
27	Date of permission of AA for distribution of unsold assets to stakeholders
28	Date of permission of the liquidator to realise the un-relinquished security interest by the secured creditor
29	Modified list of stakeholders and date of submission to AA
30	Date of first realisation
31	Date of second realisation
32	Date of first distribution
33	Date of second distribution
34	Date of submission of Quarterly Progress Report-I (FY-1)
35	Date of submission of Asset Sales Report to AA
36	Date of submission of Quarterly Progress Report-II
37	Date of submission of Quarterly Progress Report-III
38	Date of submission of Quarterly Progress Report-IV & Audit Report
39	Date of submission of Quarterly Progress Report-I (FY-2)
40	Date of submission of Quarterly Progress Report-II
41	Date of submission of Quarterly Progress Report-III
42	Date of submission of Quarterly Progress Report-IV & Audit Report
43	Date of intimation to statutory authority as applicable. a) PF b) ESI c) Income Tax Dept d) Inspector of Factory e) GST/VAT f) Others
44	Date of deposit of unclaimed dividends or undistributed proceeds and income and interest thereon, if any, under sub-regulations (2), (3) or (4) of regulation 46 (substituted vide the Insolvency and Bankruptcy Board of India (Liquidation Process) (Amendment) Regulations, 2020 dated 06.01.2020) Date of application to AA as per Reg 46(1)
45	Amount deposited into Corporate Liquidation Account: (a) Amount of unclaimed dividends (b) Amount of undistributed proceeds (c) Income referred to in sub-regulation (2) and (3) of regulation 46 (d) Interest referred to in sub-regulation (4) of regulation 46 Total (substituted vide the Insolvency and Bankruptcy Board of India (Liquidation Process) (Amendment) Regulations, 2020 dated 06.01.2020) Date of transfer of undistributed/unclaimed assets or proceeds of liquidation to public Account of India
46	Date of submission to the Board and the Authority under sub-regulation (5) of regulation 46 (substituted vide the Insolvency and Bankruptcy Board of India (Liquidation Process) (Amendment) Regulations, 2020 dated 06.01.2020) Date of intimation as per Reg 46(3)
47	Date of Final Report to AA (prior to dissolution application)

3. The details of the assets as per Asset Memorandum and Final Sale Report are as under:

SI.No.	Assets	Mode of Sale	Estimated Liquidation Value	Realisation Amount (Rs.)	Date of Transfer to Liquidation Account
(1)	(2)	(3)	(4)	(5)	(6)

4. (a) Liquidation value of the liquidation estate:

Sl. No.	Realisations	Amount (Rs.)
1.	Opening balance as on liquidation commencement date (A)
Realisations (B)
2.	Auctions of assets
3.	Private sales of assets
4.	Assignment of not readily realisable assets
5.	Distribution of unsold asset
6.	Others (specify)
Total (A+B)

(b) Amount realised from sale of liquidation estate:

(c) The amounts distributed to stakeholders as per section 52 or 53 of Code are as under:

(Amount in Rs. lakh)

SI. No.	Stakeholders* under section 53 (1)	Amount Claimed	Amount Admitted	Amount Distributed	Amount Distributed to the Amount Claimed (%)	Remarks
(1)	(2)	(3)	(4)	(5)	(6)	(7)
1	(a): CIRP Costs
2	(a): Liquidation Costs
3	(b)(i)
4	(b)(ii)
5	(c)
6	(d)
7	(e)(i)
8	(e) (ii)
9	(f)
10	(g)
11	(h)
Total

*If there are sub-categories in a category, please add rows for each sub-category.

Sl. No.	Particulars	Details
1.	Number of secured creditors who did not relinquish security interest
2.	Liquidation value of such security interest (Rs.)
3.	Amount of admitted claim of secured creditors (Rs.)
4.	Total realisation from such security interest (Rs.)
5.	Total Contribution made as per regulation 21A(2)(Rs.) (i+ii+iii)
	i. Contribution made by secured creditors toward workmen's dues (Rs.)
	ii. Contribution made by secured creditors toward unpaid CIRP and Liquidation Cost (Rs.)
	iii. the excess of the realised value of the asset (Rs.)
6.	Realised value received by secured creditor (Rs.)
7.	Date of realisation by secured creditor

Sl. No.	Particulars	Details
1.	Details of the assets
2.	Liquidation value of the assets (Rs.)
3.	Amount realised (Rs.)
4.	Name of the bidder
5.	Sharing of proceeds between bidder and creditors/ corporate debtor, if any
6.	Schedule of realisation by bidder

5. The Liquidation Process has been conducted as per the timeline indicated in regulation 47 as under:

Section of the Code / Regulation No.	Description of Task	Timeline as per regulation 47	Actual Timeline
(1)	(2)	(3)	(4)
Section 33	Commencement of LCD and Appointment of Liquidator	T	T

6. The following are deviations /non-compliances with the provisions of the Insolvency and Bankruptcy Code, 2016, regulations made, or circulars issued there under (If any deviation/ non-compliances were observed, please state the details and reasons for the same):

SI.No.	Deviation/Non-compliance observed	Section of the Code / Regulation No. / Circular No.	Reasons	Whether rectified or not
(1)	(2)	(3)	(4)	(5)
1
2
3

7. The dissolution application has been filed [before expiry of the period of one year] / [after expiry of one year]. Please state details of any extension sought with the reason and granted:

8. The details of application(s) filed / pending in respect of avoidance of transactions.

SI.No.	Type of Transaction	Date of Filing with Adjudicating Authority	Date of Order of the Adjudicating Authority	Brief of the Order
(1)	(2)	(3)	(4)	(5)
1	Preferential transactions under section 43
2	Undervalued transactions under section 45
3	Extortionate credit transactions under section 50
4	Fraudulent transactions under section 66

9. All undischarged or matters pending before any Court or Tribunal relating to corporate debtor, if any, have been reported to AA.

10. I (Name of Liquidator), hereby certify that the contents of this certificate are true and correct to the best of my knowledge and belief, and nothing material has been concealed there from.

(Signature)
Name of the Liquidator:
IP Registration No:
Address as registered with the Board:
Email id as registered with the Board:

Date:
Place:

Deposit of Unclaimed Dividends and / or Undistributed Proceeds
[Under Regulation 46 (5) of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016]

A. Details of Liquidation Process

Sl. No.	Description	Particulars
(1)	(2)	(3)
1	Name of the Corporate Debtor
2	Identification Number of CD (CIN/DIN)
3	CIRP Commencement Date
4	Liquidation Commencement Date
5	Date of Deposit into the Corporate Liquidation Account
6	Amount deposited into the Corporate Liquidation Account (Rs.)
7	Bank Account from which the amount is transferred to Corporate Liquidation Account (a) Account No: (b) Name of Bank: (c) IFSC: (d) MICR: (e) Address of Branch of the Bank:
8	Details of the Amount (Rs.) deposited into Corporate Liquidation Account (a) Unclaimed dividends (b) Undistributed proceeds (c) Income earned till the due date of deposit (d) Interest at the rate of twelve per cent on the amount retained beyond due date (Please show computation of interest amount) Total

B. Details of Stakeholders entitled to Unclaimed Dividends or Undistributed Proceeds

Sl. No.	Name of stakeholder entitled to receive unclaimed dividends or undistributed proceeds	Address, phone number and email address of the stakeholder	Identification Number of the stakeholder (PAN, CIN, Aadhar No.) (Please attach Identification proof.)	Amount due to the stakeholder (Rs.)	Nature of Amount due	Remarks
(1)	(2)	(3)	(4)	(5)	(6)	(7)
1
2
3

C. Details of Deposit made into the Corporate Liquidation Account
I (Name of Liquidator) have deposited Rs…… (Rupees ….only) into the Corporate Liquidation Account on …. vide acknowledgment no.. … dated ……

I (Name of Liquidator) hereby certify that the details provided in this Form are true and correct to the best of my knowledge and belief, and nothing material has been concealed.

(Signature)
Name of the Liquidator
IP Registration No:
Address as registered with the Board:
Email id as registered with the Board:

Date:
Place:

Withdrawal from Corporate Liquidation Account
[Under Regulation 46 (7) of the Insolvency and Bankruptcy Board of India (Liquidation Process) Regulations, 2016]

Sl. No.	Description	Particulars
(1)	(2)	(3)
1	Name of the Corporate Debtor
2	Identification Number of CD (CIN/DIN)
3	CIRP Commencement Date
4	Liquidation Commencement Date
5	Date of Dissolution Order
6	Date of Deposit into the Corporate Liquidation Account
7	Name of the Stakeholder seeking withdrawal
8	Identification Number of the Stakeholder (a) PAN (b) CIN (c) Aadhaar No.
9	Address and Email Address of Stakeholder
10	Amount of Claim of the Stakeholder, admitted by the Liquidator
11	Amount of unclaimed dividends / undistributed proceeds deposited by the liquidator in the Corporate Liquidation Account against the stakeholder
12	Amount of unclaimed dividends / undistributed proceeds the Stakeholder seeks to withdraw from the Corporate Liquidation Account
13	Bank Account to which the amount is to be transferred from the Corporate Liquidation Account, if withdrawal is approved (a) Account No.: (b) Name of Bank: (c) IFSC: (d) MICR: (e) Address of Branch of the Bank:
14	Reasons for not taking dividend or proceeds during the Liquidation Process
15	Any legal disability in applying for withdrawal? (Yes / No), If yes, please provide details

DECLARATION

I, [Name of stakeholder], currently residing at [insert address], hereby declare and state as follows:
1. I am entitled to receive a sum of Rs…. (Rupees … only) from the Corporate Liquidation Account, as presented above.
2. 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, has received any manner of satisfaction or security whatsoever, save and except the following: ……………
3. I undertake to refund the entire amount with interest as decided by the Board, in case the Board finds that I am not entitled to this amount.
4. I authorise the Board to initiate appropriate legal action against me if my claim is found false at any time.

Date:
Place:

(Signature of the Stakeholder)

VERIFICATION

I, [Name] the stakeholder hereinabove, do hereby verify that the contents of this Form 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 Stakeholder)

[Note: In the case of a 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]