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 ₹) 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 ₹) 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 ₹) 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 ₹) 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 ₹) 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 in₹) 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 in₹) 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 in₹) 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 ₹) 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 in₹) 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