Debtor) Under The Insolvency and Bankruptcy Code, 2016.: Form 5

Form 5
(See sub-rule (1) of rule 6)

APPLICATION BY OPERATIONAL CREDITOR TO INITIATE CORPORATE INSOLVENCY RESOLUTION PROCESS UNDER THE
CODE.
(Under rule 6 of the Insolvency and Bankruptcy (Application to Adjudicating Authority) Rules, 2016)
[Date]
To,
The National Company Law Tribunal
[Address]
From,
[Name and address for correspondence of the operational creditor]
In the matter of [name of the corporate debtor]
Subject: Application to initiate corporate insolvency resolution process in respect of [name of the corporate
debtor] under the Insolvency and Bankruptcy Code, 2016.
Madam/Sir,
[Name of the operational creditor], hereby submits this application to initiate a corporate insolvency resolution
process in the case of [name of corporate debtor]. The details for the purpose of this application are set out below:
Part - I
PARTICULARS OF APPLICANT
1. NAME OF OPERATIONAL CREDITOR
2. IDENTIFICATION NUMBER OF OPERATIONAL

CREDITOR (IF ANY)
3. ADDRESS FOR CORRESPONDENCE OF THE
OPERATIONAL CREDITOR
Part - II
PARTICULARS OF CORPORATE DEBTOR
1. NAME OF THE CORPORATE DEBTOR
2. IDENTIFICATION NUMBER OF CORPORATE
DEBTOR
3. DATE OF INCORPORATION OF CORPORATE
DEBTOR
4. NOMINAL SHARE CAPITAL AND THE PAID-UP
SHARE CAPITAL OF THE CORPORATE DEBTOR
AND/OR DETAILS OF GUARANTEE CLAUSE AS PER
MEMORANDUM OF ASSOCIATION (AS
APPLICABLE)
5. ADDRESS OF THE REGISTERED OFFICE OF THE
CORPORATE DEBTOR
6. NAME, ADDRESS AND AUTHORITY OF PERSON
SUBMITTING APPLICATION ON BEHALF OF
OPERATIONAL CREDITOR
(ENCLOSE AUTHORISATION)
7. NAME AND ADDRESS OF PERSON RESIDENT IN
INDIA AUTHORISED TO ACCEPT THE SERVICE OF
PROCESS ON ITS BEHALF
(ENCLOSE AUTHORISATION)
Part-III
PARTICULARS OF THE PROPOSED INTERIM RESOLUTION PROFESSIONAL [IF PROPOSED]
1. NAME, ADDRESS, EMAIL ADDRESS AND THE
REGISTRATION NUMBER OF THE PROPOSED
INSOLVENCY PROFESSIONAL
Part-IV
PARTICULARS OF OPERATIONAL DEBT
1. TOTAL AMOUNT OF DEBT,
DETAILS OF TRANSACTIONS ON ACCOUNT OF WHICH
DEBT FELL DUE,
AND THE DATE FROM WHICH SUCH DEBT FELL DUE
2. AMOUNT CLAIMED TO BE IN DEFAULT AND THE DATE
ON WHICH THE DEFAULT OCCURRED
(ATTACH THE WORKINGS FOR COMPUTATION OF
AMOUNT AND DATES OF DEFAULT IN TABULAR
FORM)
Part-V
PARTICULARS OF OPERATIONAL DEBT [DOCUMENTS, RECORDS AND EVIDENCE OF DEFAULT]
1. PARTICULARS OF SECURITY HELD, IF ANY, THE DATE OF ITS CREATION, ITS ESTIMATED VALUE AS PER THE
CREDITOR.
ATTACH A COPY OF A CERTIFICATE OF REGISTRATION OF CHARGE ISSUED BY THE REGISTRAR OF COMPANIES (IF
THE CORPORATE DEBTOR IS A COMPANY)
2. DETAILS OF RESERVATION / RETENTION OF TITLE ARRANGEMENTS (IF ANY) IN RESPECT OF GOODS TO WHICH
THE OPERATIONAL DEBT REFERS
3. PARTICULARS OF AN ORDER OF A COURT, TRIBUNAL OR ARBITRAL PANEL ADJUDICATING ON THE DEFAULT, IF
ANY
(ATTACH A COPY OF THE ORDER)
4. RECORD OF DEFAULT WITH THE INFORMATION UTILITY, IF ANY
(ATTACH A COPY OF SUCH RECORD)
5. DETAILS OF SUCCESSION CERTIFICATE, OR PROBATE OF A WILL, OR LETTER OF ADMINISTRATION, OR COURT
DECREE (AS MAY BE APPLICABLE), UNDER THE INDIAN SUCCESSION ACT, 1925 (10 OF 1925)
(ATTACH A COPY)
6. PROVISION OF LAW, CONTRACT OR OTHER DOCUMENT UNDER WHICH OPERATIONAL DEBT HAS BECOME DUE
7. A STATEMENT OF BANK ACCOUNT WHERE DEPOSITS ARE MADE OR CREDITS RECEIVED NORMALLY BY THE
OPERATIONAL CREDITOR IN RESPECT OF THE DEBT OF THE CORPORATE DEBTOR (ATTACH A COPY)
8. LIST OF OTHER DOCUMENTS ATTACHED TO THIS APPLICATION IN ORDER TO PROVE THE EXISTENCE OF
OPERATIONAL DEBT AND THE AMOUNT IN DEFAULT
I, [Name of the operational creditor / person authorised to act on behalf of the operational creditor] hereby certify that,
to the best of my knowledge, [name of proposed insolvency professional], is fully qualified and permitted to act as an
insolvency professional in accordance with the Code and the rules and regulations made thereunder. [WHERE
APPLICABLE]
[Name of the operational creditor] has paid the requisite fee for this application through [state means of payment] on
[date].
Yours sincerely,
Signature of person authorised to act on behalf of the operational creditor
Name in block letters
Position with or in relation to the operational creditor
Address of person signing
Instructions
Please attach the following to this application:
Annex I Copy of the invoice / demand notice as in Form 3 of the Insolvency and
Bankruptcy (Application to
Adjudicating Authority) Rules, 2016 served on the corporate debtor.
Annex II Copies of all documents referred to in this application.
Annex III Copy of the relevant accounts from the banks/financial institutions maintaining
accounts of the
operational creditor confirming that there is no payment of the relevant unpaid operational debt
by the
operational debtor, if available.
Annex IV Affidavit in support of the application in accordance with the Insolvency and
Bankruptcy (Application to
Adjudicating Authority) Rules, 2016.
Annex V Written communication by the proposed interim resolution professional as set out in Form 2
of the
Insolvency and Bankruptcy (Application to Adjudicating Authority) Rules, 2016. [WHERE
APPLICABLE]
Annex VI Proof that the specified application fee has been paid.
Note: Where workmen/employees are operational creditors, the application may be made either in an
individual capacity or in a joint capacity by one of them who is duly authorised for the purpose.

Debtor) Under The Insolvency and Bankruptcy Code, 2016.: Form 5

Uploaded by

Debtor) Under The Insolvency and Bankruptcy Code, 2016.: Form 5

Uploaded by

Form 5

(See sub-rule (1) of rule 6)

2. IDENTIFICATION NUMBER OF OPERATIONAL

Please attach the following to this application:

Annex II Copies of all documents referred to in this application.

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