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Formats under the Insolvency and Bankruptcy Board of India (Voluntary Liquidation Process) Regulations, 2017.

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.... Sl. No. Regulation Description Form 1 Regulation 14 Public Announcement Form A 2 Regulation 16 Proof of Claim by Operational Creditors except Workmen and Employees Form B 3 Regulation 17 Proof of Claim by Financial Creditors Form C 4 Regulation 18(1) Proof of Claim by a Workman or Employee Form D 5 Regulation 18(2) Proof of Claim by Authorised Representative of Workmen or Employees Form E 6 Regulation 19 Proof of Claim by Any Other Stakeholder Form F 7 Regulation 39(5) Deposit of Unclaimed Dividends and/or Undistributed Proceeds into Corporate Voluntary Liquidation Account Form G 8 Regulation 38(3) Compliance Certificate Form H 9 Regulation 39(7) Withdrawal from Corporate Voluntary Liquidation Account Form I 10 Regulation 42(2) Intimation for Termination of Voluntary Liquidation Proceedings Form J 3. The formats of the above Forms are enclosed at the Annexure to this Circular. 4. This Circular is issued in exercise of the powers conferred under section 196 read with section 240 of the Code. Sd/- (Jithesh John) Executive Director Anne....

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....low: 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 voluntary liquidation process commencement date and details of nature of claim   4. Details of any dispute as well as the record of pendency of suit or arbitration proceedings   5. Details of how and when debt incurred   6. Details of any mutual credit, mutual debts, or other mutual dealings between the corporate person and the operational creditor which may be set-off against the claim   7. Details of any retention of title in respect of goods or properties to which the debt refers or any other security   8. Details of any assignment or transfer of debt in his favour   ....

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....lief. Nothing is false and nothing material has been concealed therefrom. Verified at ___________ on this _________ day of _________ 201______ Deponent's signature FORM C PROOF OF CLAIM BY FINANCIAL CREDITORS (Under Regulation 17 of the Insolvency and Bankruptcy Board of India (Voluntary Liquidation Process) Regulations, 2017) [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 voluntary liquidation of [name of corporate person] under the Insolvency and Bankruptcy Code, 2016. Madam/Sir, [Name of the financial creditor] hereby submits this proof of claim in respect of the voluntary liquidation of [name of corporate person]. 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)         &nb....

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....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 person 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 _______....

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.... person], the corporate person was, at the liquidation commencement date, that is, the ________ day of ____________20____, justly and truly indebted to me for a sum of Rs. [insert amount of claim]. 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 claim] The said documents are true, valid and genuine to the best of my knowledge, information and belief. 3. 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 person 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....

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....orkmen / employee which may be set-off against the claim. 3. Please list out and attach the documents relied on to prove the claim. 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 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.           AFFIDAVIT I, [insert full name, address and occupation of deponent] do solemnly affirm and state as follows: 1. The above named corporate person was, at the liquidation commencement date that is, the _______day of _______20 ___and still is, justly and truly indebted to the workmen and employees for a 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: [Plea....

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.... claim   4. Details of how and when claim arose   5. Details of any mutual credit, mutual debts, or other mutual dealings between the corporate person and the other stakeholder which may be set-off against the claim   6. Details of any retention of title in respect of goods or properties to which the claim refers   7. Details of any assignment or transfer of debt in his favour   8. Details of the bank account to which the other stakeholder's share of the proceeds of liquidation can be transferred   9. List out and attach the Documents by reference to which the claim can be substantiated or which can be relied upon in support of the Claim.     Signature of 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....

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....count No: b. Name of Bank: c. IFSC: d. MICR: e. Address of Branch of the Bank:   7 Details of the Amount (Rs.) deposited into Corporate Voluntary 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 entitle d to receive unclaimed dividends or undistributed proceeds Address, phone number and email address of the stakeholder Identification Number of the stake holder (PAN, CIN, etc. ) (Please attach Identification proof -) Amount due to the stakeholder (Rs.) Nature of Amount due Applicable section of the Income Tax Act, 1961 or any other law under which tax is to be deducted Amount of tax to be de ducted (Rs.) Reason for unclaimed dividends or undistributed proceeds Remarks (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 1 &....

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....of Factory e. GST/VAT f. RBI g. Others   12 Amount deposited into Corporate Voluntary Liquidation Account: a. Amount of unclaimed dividends b. Amount of undistributed proceeds c. Income referred to in sub-regulation (2) and (3) of regulation 39 d. Interest referred to in sub-regulation (4) of regulation 39 Total   13 Remuneration of Liquidator (Rs.)   2. Details of the corporate person: Sl. No. Particulars Description (1) (2) (3) 1 Year of Incorporation   2 Objects in brief   3 Paid up Share Capital / Capital (Amount in Rs.)   4 Assets as on Liquidation Commencement date (Amount in Rs.)   5 Debt payable as on Liquidation Commencement date (Amount in Rs.)   6 Net-worth of the Corporate Person (Amount in Rs.)   7 Reasons for initiating voluntary liquidation, in brief   3. Details of realisation during Voluntary Liquidation Process: Sl. No. Particulars Amount (Rs) (1) (2) (3) 1 Sale of Assets   2 Refund from Statutory Authorities   3 ....

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....ry liquidation process and appointment of insolvency professional as liquidator T=0     3 Proviso to Section 59(3)(c), Regulation 3(1)(c) Approval of creditors representing two-third in value of debt, if the corporate person owes any debt, of the resolution passed under section 59(3)(c) or regulation 3(1)(c) T+7     4 Regulation 5(2) Intimation by Insolvency Professional regarding his appointment as Liquidator, to the Board T+7     5 Regulation 14 (1) Public Announcement in Form A by the Liquidator T+5     6 Section 59(4), Reg. 3(2) Notification to Registrar of Companies and Board about the resolution passed under section 59(3)(c) and regulation 3(1)(c) or subsequent approval of creditors thereto, as the case may be, by corporate person T + 7 or T + 14     7 Regulation 14 (2) Submission of claims by stakeholders T+ 30     8 Regulation 9(1) Submission of preliminary report to the corporate person by the Liquidator T + 45     9 Regulation 29 Verification of claims by the Liquidator T+ 60 ....

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....tionate credit transactions under section 50       4 Fraudulent transactions under section 66       8. If the process has taken more than 90 / 270 days, as the case may be, for completion, please state reasons thereof. 9. All undischarged matters pending, if any, before any Court or Tribunal relating to corporate person have been reported to AA, along with the details of provision made to sufficiently meet the obligations arising from such pending litigations. 10. The records referred to in regulations 8 and 10 shall be preserved as mandated under regulation 41. 11. Any other information which the Liquidator may like to submit. 12. 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: ......................] ***** FORM-I Withdrawal from Corporate Voluntary Liquidation Account [Unde....

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....aim 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/ designated partner and in the case of other entities, an officer authorised for the purpose by the entity] FORM J INTIMATION FOR TERMINATION OF VOLUNTARY LIQUIDATION PROCEEDINGS [Under Regulation 42 of Insolvency and Bankruptcy Board of India (Voluntary Liquidation Process) Regulations, 2017] Date:___________ To The Adjudicating Authority [National Company Law Tribunal, _______Bench] In the matter of: [name of the corporate person] Subject: Intimation for termination of voluntary liquidation proceedings of [name of the corporate person] I, [Name of the Insolvency Professional], an insolvency professional enrolled with [name ....