CLAIM WITH PROOF BY A CREDITOR - Application to Adjudicating Authority for Bankruptcy Process

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..... or ], hereby submits this proof of claim in respect of the bankruptcy process in the case of [ name of bankrupt ]. The details for the same are set out below: S. No. Particulars 1. Title and full name of creditor 2. Identification number of creditor Aadhar PAN CIN GSTIN 3. Address .....

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..... Details of any retention of title arrangements in respect of goods or properties to which the claim refers 10. Details of the bank account to which the amount of the claim or any part thereof can be transferred pursuant to a repayment plan 11. Details of any security held (including value and date when it was given) 12. .....

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..... xistence and non-payment of claim due to the creditor 14. Details of bank account to which the share of creditor s proceeds from bankruptcy can be deposited. Signature of creditor or person authorised to act on his behalf [ Please enclose the authority if this is being submitted on behalf of a creditor ] Name in block letters Address of person signing DECLARATION I, [name of claimant], currently residing at .....

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