CLAIM WITH PROOF BY A CREDITOR - Application to Adjudicating Authority for Bankruptcy Process

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....ankruptcy Trustee] [Address as set out in public notice] From [Name and address of the creditor] Subject: Submission of claims with proof. Madam/Sir, [Name of the creditor], hereby submits this proof of claim in respect of the bankruptcy process in the case of [name of bankrupt]. The details for the same are set out below: S. No. Particulars 1. Title and full name of creditor ....

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....s to which the claim refers 10. Details of the bank account to which the amount of the claim or any part thereof can be transferred pursuant to a repayment plan 11. Details of any security held (including value and date when it was given) 12. For secured creditors only Tick whichever is applicable - __security interest is being enforced __ Security interest is being relinquished. ....

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....ty. If security is being realised, specify balance amount of debt which is being claimed. 13. List of documents attached to this proof of claim in order to prove the existence and non-payment of claim due to the creditor 14. Details of bank account to which the share of creditor's proceeds from bankruptcy can be deposited. Signature of creditor or person authorised to act on his behalf ....