FORM P10 - LIST OF CLAIMS - Insolvency and Bankruptcy Board of India (Pre-packaged Insolvency Resolution Process) Regulations, 2021

FORM P10 LIST OF CLAIMS (Under regulation 20 of the Insolvency and Bankruptcy Board of India (Pre-packaged Insolvency Resolution Process) Regulations, 2021) As on________________ (Amount in Rs.) Sl. No. Category of creditor Summary of claims Amount of contingent claims Details in Annexure Remarks, if any No. of claims Amount I II III IV V VI VII 1 Secured financial creditors belonging to any class of creditors 1 2 Unsecured financial creditors belonging to any class of creditors 2 3 Secured financial creditors (other than financial creditors belonging to any class of creditors) 3 4 Unsecured financial creditors (other than financial creditors belonging to any class of creditors) 4 5 Operational creditors (Workmen) 5 6 Operational creditors (Employees) 6 7 Operational creditors (Government dues) 7 8 Operational creditors (other than Workmen, Employees and Government dues) 8 9 Other creditors, if any, (other than financial creditors and operational creditors) 9 Total [For Corporate Debtor] Signature Name of person submitting the information Relationship with corporate debtor OR [For Resolution Professional] Signature Name of Insolvency Professional Registration Number____ Annexure-1 Name of the corporate debtor: Date of commencement of PPIRP: . List of creditors as on: List of secured financial creditors belonging to any class of creditors (Amount in Rs.) Sl. No. Name of creditor Identification No. Details of claims Amount of contingent claim Amount of any mutual dues, that may be set- off Remarks, if any Amount of claim Nature of claim Amount covered by security interest Amount covered by guarantee Whether related party. % of voting share in committee I II III IV V VI VII VIII IX X XI XII 1 2 3 Annexure-2 Name of the corporate debtor: Date of commencement of PPIRP: List of creditors as on: List of unsecured financial creditors belonging to any class of creditors (Amount in Rs.) Sl. No. Name of creditor Identification No. Details of claims Amount of contingent claim Amount of any mutual dues, that may be set- off Remarks, if any Amount of claim Nature of claim Amount covered by guarantee Whether related party. % of voting share in committee I II III IV V VI VII VIII IX X XI 1 2 3 Annexure 3 Name of the corporate debtor: Date of commencement of PPIRP: .. List of creditors as on: List of secured financial creditors (other than financial creditors belonging to any class of creditors) (Amount in Rs.) Sl. No. Name of creditor Identification No. Details of claims Amount of contingent claim Amount of any mutual dues, that may be set- off Remarks, if any Amount of claim Nature of claim Amount covered by security interest Amount covered by guarantee Whether related party. % of voting share in committee I II III IV V VI VII VIII IX X XI XII 1 2 3 Annexure 4 Name of the corporate debtor: Date of commencement of PPIRP: . List of creditors as on: List of unsecured financial creditors (other than financial creditors belonging to any class of creditors) (Amount in Rs.) Sl. No. Name of creditor Identification No. Details of claims Amount of contingent claim Amount of any mutual dues, that may beset- off Remarks, if any Amount of claim Nature of claim Amount covered by guarantee Whether related party. % of voting share in committee I II III IV V VI VII VIII IX X XI 1 2 3 Annexure 5 Name of the corporate debtor: Date of commencement of PPIRP: List of creditors as on: List of operational creditors (Workmen) (Amount inRs.) Sl. No. Name of workman Identification No. Details of claims Amount of contingent claim Amount of any mutual dues, that may be set-off Remarks, if any Amount of claim Nature of claim Whether related party. % voting share in committee, if applicable I II III IV V VI VII VIII IX X 1 2 3 Annexure 6 Name of the corporate debtor: Date of commencement of PPIRP: . List of creditors as on: List of operational creditors (Employees) (Amount inRs.) Sl. No. Name of employee Identification No. Details of claims Amount of contingent claim Amount of any mutual dues, that may be set-off Remarks, if any Amount of claim Nature of claim Whether related party. % of voting share in committee, if applicable I II III IV V VI VII VIII IX X 1 2 3 Annexure 7 Name of the corporate debtor: Date of commencement of PPIRP: . List of creditors as on: List of operational creditors (Government dues) (Amount inRs.) Sl. No Details of Government organisation Details of claims Amount of Amount of any mutual dues, that may be set-off Remarks, if any Department Government Identification Amount of claim Nature of Claim Amount covered by security interest Amount covered by guarantee % of voting share in committee, if applicable I II III IV V VI VII VIII IX X XI XII 1 2 3 Annexure 8 Name of the corporate debtor: Date of commencement of PPIRP: . List of creditors as on: List of operational creditors (Other than Workmen and Employees and Government dues) (Amount in Rs.) Sl.No. Name of creditor Identification No. Details of claim Amount of contingent claim Amount of any mutual dues, that may be set-off Remarks, if any Amount of claim Nature of claim Amount covered by security interest Amount covered by guarantee Whether related party. % of voting share in committee I II III IV V VI VII VIII IX X XI XII 1 2 3 Annexure 9 Name of the corporate debtor: Date of commencement of PPIRP: . List of creditors as on: List of other creditors (Other than financial creditors and operational creditors) (Amount inRs.) Sl.No. Name of creditor Identification No. Details of claim Amount of contingent claim Amount of any mutual dues, that may be set- off Remarks, if any Amount of claim Nature of claim Amount covered by security interest Amount covered by guarantee Whether related party. I II III IV V VI VII VIII IX X XI 1 2 3