GSTN: 19AADFP9388F1ZO Partners Details
GSTN: 19AADFP9388F1ZO Partners Details
GSTN: 19AADFP9388F1ZO Partners Details
FORM B
(Under Regulation 7 of the Insolvency and Bankruptcy Board of India (Insolvency Resolution
Process for Corporate Persons) Regulations, 2016)
[Date]
To
The Interim Resolution Professional / Resolution Professional
[SUBODH KUMAR AGARWAL]
[1 Ganesh Chandra Avenue Room 301-3rd Floor, Kolkata-700 013]
From
PNEUMATIC & INDUSTRIAL CO
SHOP NO 30/42, GROUND FLOOR, 33/1,NETAJI SUBHAS ROAD, N S ROAD, Kolkata, West
Bengal, 700001
Madam/Sir,
PNEUMATIC & INDUSTRIAL CO, hereby submits this proof of claim in respect of the
corporate insolvency resolution process in the case of [BIL INFRATECH LTD]. The details for
the same are set out below:
PARTICULARS
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3. ADDRESS AND EMAIL ADDRESS OF SHOP NO 30/42, GROUND FLOOR,
OPERATIONAL CREDITOR FOR 33/1,NETAJI SUBHAS ROAD, N S ROAD,
CORRESPONDENCE Kolkata, West Bengal, 700001
EMAIL:
[email protected]
PARTICULARS
95 N.A
9. [ DETAILS OF:
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11. LIST OF DOCUMENTS ATTACHED TO THIS INVOICES
CHALLANS
PROOF OF CLAIM IN ORDER TO PROVE THE
TRANSPORT COPY
EXISTENCE AND NON-PAYMENT OF CLAIM
DUE TO THE OPERATIONAL CREDITOR
95
Substituted by Notification No. IBBI/2019-20/GN/REG052, dated 27th November, 2019 (w.e.f. 28.11.2019).
Before substitution, it stood as under: “DETAILS OF ANY RETENTION OF TITLE ARRANGEMENTS IN RESPECT OF GOODS
OR PROPERTIES TO WHICH THE CLAIM REFERS”.
PARTICULARS
*PAN number, passport, AADHAAR Card or the identity card issued by the Election
Commission of India
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96
[DECLARATION
I, [ALIAKBER BHAIMOMIN], currently residing at [8 GRANT LANE, KOLKATA-700012],
hereby declare and state as follows:-
1. [BIL INFRATECH LTD], the corporate debtor was, at the insolvency commencement date,
being the 28.day of JULY 2021.., actually indebted to me in the sum of Rs.323947.00
[Three lacs twenty three thousand nine hundred forty seven].
2. In respect of my claim of the said sum or any part thereof, I have relied on the documents
specified below: [INVOICES, CHALLANS, TRANSPORT COPIES].
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.
4. In respect of the said sum or any part thereof, neither I nor 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:
[NA].
Date:
Place:
(Signature of the claimant)
96
Substituted by Notification No. IBBI/ 2017-18/GN/REG030, dated 27th March, 2018 (w.e.f. 01-04-2018) for
Affidavit and Verification
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are
true and correct to my knowledge and belief and no material fact has been concealed therefrom.
[Note: In the case of company or limited liability partnership, the declaration and verification
shall be made by the director/manager/secretary and in the case of other entities, an officer
authorised for the purpose by the entity].]
56
57
SCHEDULE
97
[FORM C
SUBMISSION OF CLAIM BY FINANCIAL CREDITORS
(Under Regulation 8 of the Insolvency and Bankruptcy Board of India (Insolvency Resolution
Process for Corporate Persons) Regulations, 2016)
[Date]
From
PNEUMATIC & INDUSTRIAL CO
SHOP NO 30/42, GROUND FLOOR, 33/1,NETAJI SUBHAS ROAD, N S ROAD, Kolkata, West
Bengal, 700001
To
The Interim Resolution Professional / Resolution Professional
[Name of the Insolvency Resolution Professional / Resolution Professional]
[Address as set out in public announcement]
58
Subject: Submission of claim and proof of claim.
Madam/Sir,
[Name of the financial creditor], hereby submits this claim in respect of the corporate insolvency
resolution process of [name of corporate debtor]. The details for the same are set out below:
Relevant Particulars
(1) (2) (3)
1. Name of the financial creditor PNEUMATIC &
INDUSTRIAL CO
KAIZER
MOHAMEDBHAI
BHAIMOMIN:
ADUPB1377J
3. Address and email address of the financial creditor for EMAIL:
correspondence akbarali.bhaimomin@g
mail.com
SHOP NO 30/42,
GROUND FLOOR,
33/1,NETAJI
SUBHAS ROAD, N S
ROAD, Kolkata,
West Bengal,
700001
97
Substituted by Notification No. IBBI/2020-21/GN/REG070, dated 15th March, 2021 (w.e.f. 15.03.2021).
59
4. Details of claim, if it is made against corporate debtor as (i) RS. 323947.00
principal borrower:
(i) Amount of claim
(ii) Amount of claim covered by security interest, if any
(Please provide details of security interest, the value of the
security, and the date it was given)
(iii) Amount of claim covered by guarantee, if any
(Please provide details of guarantee held, the value of the
guarantee, and the date it was given)
(iv) Name and address of the guarantor(s)
5. Details of claim, if it is made against corporate debtor as
guarantor:
(i) Amount of claim
(ii) Amount of claim covered by security interest, if any
(Please provide details of security interest, the value of the
security, and the date it was given)
(iii) Amount of claim covered by guarantee, if any
(Please provide details of guarantee held, the value of the
guarantee, and the date it was given)
(iv) Name and address of the principal borrower
6. Details of claim, if it is made in respect of financial debt
covered under clauses (h) and (i) of sub-section (8) of section 5
of the Code, extended by the creditor:
(i) Amount of claim
(ii) Name and address of the beneficiary
7. Details of how and when debt incurred
8. 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
9. Details of the bank account to which the amount of the claim or
any part thereof can be transferred pursuant to a resolution plan
DECLARATION
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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 for a 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.
4. In respect of the said sum or any part thereof, neither I, nor 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:
[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].
5. I undertake to update my claim as and when the claim is satisfied, partly or fully, from
any source in any manner, after the insolvency commencement date.
6. I am / I am not a related party of the corporate debtor, as defined under section 5 (24) of
the Code.
7. I am eligible to join committee of creditors by virtue of proviso to section 21 (2) of the
Code even though I am a related party of the corporate debtor.
Date:
Place:
(Signature of the claimant)
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are
true and correct to my knowledge and belief and no material fact has been concealed therefrom.
[Note: In the case of company or limited liability partnership, the declaration and verification
shall be made by the director/manager/secretary/designated partner and in the case of other
entities, an officer authorised for the purpose by the entity.]]
FORM CA
SUBMISSION OF CLAIM BY FINANCIAL CREDITORS IN A CLASS
(Under Regulation 8Aof the Insolvency and Bankruptcy (Insolvency Resolution Process for
Corporate Persons) Regulations, 2016)
[Date]
From
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[Name and address of the financial creditor, including address of its registered office and
principal office]
To
The Interim Resolution Professional / Resolution Professional
[Name of the Insolvency Resolution Professional / Resolution Professional]
[Address as set out in public announcement]
Madam/Sir,
[Name of the financial creditor], hereby submits this claim in respect of the corporate insolvency
resolution process of [name of corporate debtor]. The details for the same are set out below:
RELEVANT PARTICULARS
62
may be set-off against the claim
8. Details of any security held, the value of the security, and the
date it was given
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
for a 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.
63
4. In respect of the said sum or any part thereof, neither I, nor 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:
[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].
5. I am / I am not a related party of the corporate debtor, as defined under section 5 (24)
of the Code.
6. I am eligible to give voting instruction to the authorized representative by virtue of
proviso to section 21 (2) of the Code even though I am a related party of the
corporate debtor.
Date:
Place:
(Signature of the claimant)
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are
true and correct to my knowledge and belief and no material fact has been concealed therefrom.
SCHEDULE
FORM D
(Under Regulation 9 of the Insolvency and Bankruptcy (Insolvency Resolution Process for
Corporate Persons) Regulations, 2016)
[Date]
To
The Interim Resolution Professional / Resolution Professional
[Name of the Insolvency Resolution Professional / Resolution Professional]
[Address as set out in public announcement]
64
From
[Name and address of the workman / employee]
Madam/Sir,
[Name of the workman / employee], hereby submits this proof of claim in respect of the corporate
insolvency resolution process in the case of [name of corporate debtor]. The details for the same
are set out below:
PARTICULARS
98
[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].
98
Substituted by Notification No. IBBI/ 2017-18/ GN/ REG030, dated 27th March 2018 (w.e.f. 01-04-2018) for
Affidavit and Verification.
66
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.
4. In respect of the said sum or any part thereof, neither I, nor 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:
[Please state details of any mutual credit, mutual debts, or other mutual dealings between
the corporate debtorand the creditor which may be set-off against the claim].
Date:
Place:
(Signature of the claimant)
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are
true and correct to my knowledge and belief and no material fact has been concealed therefrom.
SCHEDULE
FORM E
(Under Regulation 9 of the Insolvency and Bankruptcy (Insolvency Resolution Process for
Corporate Persons) Regulations, 2016)
[Date]
To
The Interim Resolution Professional / Resolution Professional,
[Name of the Insolvency Resolution Professional / Resolution Professional]
[Address as set out in public announcement]
From
[Name and address of the duly authorised representative of the workmen / employees]
Madam/Sir,
67
I, [name of authorised representative of the workmen / employees], currently residing at [address
of authorised representative of the workmen / employees], on behalf of the workmen and
employees employed by the above named corporate debtor and listed in Annexure A, solemnly
affirm and say:
1. That the above named corporate debtor was, at the insolvency commencement date, being
the day of 20 , justly truly indebted to the several persons whose
names, addresses, and descriptions appear in the Annexure A below in amounts severally
set against their names in such Annexure A for wages, remuneration and other amounts
due to them respectively as workmen or/ and employees in the employment of the
corporate debtor in respect of services rendered by them respectively to the corporate
debtor during such periods as are set out against their respective names in the said
Annexure A.
2. That for which said sums or any part thereof, they have not, nor has any of them, had or
received any manner of satisfaction or security whatsoever, save and except the
following:
[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.]
Deponent
ANNEXURE
1.
2.
3.
4.
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2. Particulars of how debt was incurred by the corporate debtor, including particulars of any
dispute as well as the record of pendency of suit or arbitration proceedings (if any).
3. Particulars 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.
ATTACHMENTS:
99
[Documents relied as evidence as proof of debt and as proofs of non-payment of debt.]
100
[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.
4. In respect of the said sum or any part thereof, neither I, nor 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:
[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].
Date:
Place:
(Signature of the claimant)
99
Substituted by Notification No. IBBI/ 2017-18/ GN/ REG030, dated 27th March, 2018 (w.e.f. 01-04-2018).
100
Substituted by Notification No. IBBI/ 2017-18/ GN/ REG030, dated 27th March, 2018 (w.e.f. 01-04-2018) for
Affidavit and Verification.
69
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are
true and correct to my knowledge and belief and no material fact has been concealed therefrom.
101
[FORM F]
PROOF OF CLAIM BY CREDITORS (OTHER THAN FINANCIAL CREDITORS AND OPERATIONAL
CREDITORS)
[Under Regulation 9A of the Insolvency and Bankruptcy Board of India (Insolvency Resolution
Process for Corporate Persons) Regulations, 2016]
Date ………..
To
The Interim Resolution Professional / Resolution Professional
[Name of the Insolvency Resolution Professional / Resolution Professional]
[Address as set out in public announcement]
From
[Name and address of the creditor]
Madam / Sir,
I, [Name of the creditor], hereby submit 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 (Including the
101
Inserted by Notification No. IBBI/2017-18/ GN/REG013, dated 16th August, 2017 (w.e.f. 16-8-2017).
70
amount of the claim as at the insolvency
commencement date)
5. Details of documents by reference to which
claim can be substantiated
6. Details of how and when the claim arose
7. 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
8. Details of:
a. any security held, the value of security and
its date, or
b. retention title arrangement in respect of
goods or properties to which the claim refers
9. Details of bank account to which the amount
of the claim or any part thereof can be
transferred pursuant to a resolution plan
10. List of documents attached to this claim in
order to prove the existence and non-
satisfaction of claim due to the creditor
* PAN, Passport, AADHAAR or the identity card issued by the Election Commission of India.
102
[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].
102
Subs. by Notification No. IBBI/ 2017-18/ GN/ REG030, dated 27th March, 2018 (w.e.f. 01-04-2018) for Affidavit
and Verification.
71
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.
4. In respect of the said sum or any part thereof, neither I, nor 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:
[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].
Date:
Place:
(Signature of the claimant)
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim are
true and correct to my knowledge and belief and no material fact has been concealed therefrom.
103
[FORM FA
APPLICATION FOR WITHDRAWAL OF CORPORATE INSOLVENCY RESOLUTION PROCESS
[Under Regulation 30A of the Insolvency and Bankruptcy Board of India (Insolvency Resolution Process for
Corporate Persons) Regulations, 2016]
[Date]
103
Substituted by Notification No. IBBI/2019-20/GN/REG048, dated 25th July, 2019 (w.e.f. 25-07-2019).
72