Process) Regulations, 2016) : Schedule Ii Form D Proof of Claim by Financial Creditors

SCHEDULE II

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 Devendra jain,
(Liquidator of Sandhya Prakash Limited),
Mall Management Office, Shop No. 6,

2nd Floor, Aura Mall,
Opposite Rajeev, Gandhi College
Trilanga, Gulmohar, E-8, Arera Colony
Bhopal( M.P )-4620239
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 Sandhya Prakash Limited 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 Sandhya
Prakash Limited. 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, PRINCIPAL :

AS AT THE LIQUIDATION COMMENCEMENT DATE AND
INTEREST :
DETAILS OF NATURE OF CLAIM (WHETHER TERM LOAN,
SECURED, UNSECURED) 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
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 (i)

SUPPORT OF THE CLAIM. (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 co-partners], 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.

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SCHEDULE II

PROOF OF CLAIM BY FINANCIAL CREDITORS

Mall Management Office, Shop No. 6,

Bhopal( M.P )-4620239

2. ADDRESS AND EMAIL OF FINANCIAL CREDITOR FOR

3. TOTAL AMOUNT OF CLAIM, INCLUDING ANY INTEREST, PRINCIPAL :

4. DETAILS OF DOCUMENTS BY REFERENCE TO WHICH THE

5. DETAILS OF ANY ORDER OF A COURT OF TRIBUNAL THAT

6. DETAILS OF HOW AND WHEN DEBT INCURRED

7. DETAILS OF ANY MUTUAL CREDIT, MUTUAL DEBTS, OR

8. DETAILS OF ANY SECURITY HELD, THE VALUE OF THE

10. DETAILS OF THE BANK ACCOUNT TO WHICH THE

11. LIST OUT AND ATTACH THE DOCUMENTS RELIED ON IN (i)

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

Name in BLOCK LETTERS

Position with or in relation to creditor

Address of person signing

[Please list the documents relied on as evidence of debt and of non-payment.]

Solemnly, affirmed at on day, the day

Verified at on this day of 201 .

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