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Submission of proof of claim.- Regulation 9A - Insolvency Resolution Process for Corporate Persons

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..... the following proof of claim in respect of the corporate insolvency resolution process in the case of [name of corporate debtor]. The details of the same are set out below: PARTICULARS 1. Name of the creditor 2. Identification number of the creditor (If an incorporated body corporate, provide identification number and proof of incorporation. If a partnership or individual, provide identification record* of all partners or the individuals) 3. Address and email address of the creditor for correspondence 4. Description of the claim (In .....

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..... , AADHAAR or the identity card issued by the Election Commission of India. 2 [ DECLARATION I, [ Name of claimant ], currently residing at [ insert address ], do hereby declare and state as follows: - 1. [ Name of corporate debtor ], the corporate debtor was, at the insolvency commencement date, being the ..day of ..20 ., actually indebted to me in the 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 ]. 3. The said documents are true, valid and genuine to the best of my knowledge, information and belief and no material facts have been concealed therefrom. .....

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..... ly indebted to me for the claim, the value of which amounts to Rupees. [ insert amount of claim ]. 2. In respect of my claim, I have relied on the documents specified below: [Please list the documents relied on as evidence of claim] 3. The said documents are true, valid and genuine to the best of my knowledge, information and belief. 4. In respect of the claim, 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 (if any): [Please state details of any mutual credit, mutual debts, or other mutual dealings between the corporate debtor and the creditor which may be set-off against the claim.] Sole .....

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