Application for recognition as an insolvency professional entity- Regulation 12-Insolvency Professionals

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..... uptcy Board of India (Insolvency Professionals) Regulations, 2016. The details of the applicant and its directors / partners are as under: A. DETAILS OF APPLICANT 1. Name: 2. Address: i. registered office: ii. principal place(s) of business, if any: iii. Address for Correspondence with the Applicant iv. E-mail address for correspondence with the Applicant: v. Telephone number for correspondence with the Applicant: 3. Nature of constitution: Company /Limited Liability Partnership/ Registered Partnership (strike off whichever is not applicable) 4. Corporate Identification Number (CIN)/ LLP Identification Number (LLPIN)/ Certificate of Registration: 5. PAN: 6. GSTIN (if available): 7. Name, designation and contac .....

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..... fessional (Yes / No) Registration No. as an insolvency professional, if applicable (1) (2) (3) (4) (5) (6) (ii) In case of Company Sl. No. Name of Shareholder Number of shares held % of shares held Whether shareholder is a director (Yes / No) Whether shareholder is an insolvency professional (Yes / No) Registration no. as an insolvency professional, if applicable (1) (2) (3) (4) (5) (6) (7) 5. Whether the applicant was at any time in the past derecognised as an insolvency professional entity. (Yes/No) If yes, please furnish the date of derecognition and ground for derecognition. 6. Whether any disciplinary proceeding has been initiated by the Board (IBBI) or the Insolvency Pr .....

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..... s of the applicant (including Provisional Financial Statements, as on same date on which net worth of applicant has been submitted) 8. Copy of Certificate of Registration issued by the Board to IPs who are directors or partners, as the case may be, of applicant 9. Evidence of deposit / payment of fee, along with GST, as required under regulation 12(2) of IP Regulations.] *********** NOTES:- 1. Substituted vide Notification No. IBBI/2019-20/GN/REG049 dated 25-10-2019 before it was read as "FORM C [Under Regulation 12 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016] To The Chairperson Insolvency and Bankruptcy Board of India Sub.: Application for recognition as an insolvency prof .....

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