PROOF OF CLAIM BY OPERATIONAL CREDITORS EXCEPT WORKMEN AND EMPLOYEES- Regulation 7- Insolvency Resolution Process for Corporate Persons

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..... 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 1. NAME OF OPERATIONAL CREDITOR 2. IDENTIFICATION NUMBER OF OPERATIONAL CREDITOR (IF AN INCORPORATED BODY PROVIDE IDENTIFICATION NUMBER AND PROOF OF INCORPORATION. IF A PARTNERSHIP OR INDIVIDUAL PROVIDE IDENTIFICATION RECORDS* OF ALL THE PARTNERS OR THE INDIVIDUAL) 3. ADDRESS AND EMAIL ADDRESS OF OPERATIONAL CREDITOR FOR CORRESPONDENCE 4. TOTAL AMOUNT OF CLAIM (INCLUDING ANY INTEREST AS AT THE INSOLVENCY COMMENCEMENT DATE) 5. DETAILS OF DOCUMENTS BY REFERENCE TO WHICH THE DEBT CAN BE SUBSTANTIATED. 6. DETAILS OF ANY DISPUTE AS WELL AS THE RECORD OF PENDENCY OR OR .....

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..... uments 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 ver .....

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..... e 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.] Solemnly, affirmed at [insert place] on . . . . . . . . . . day, the . . . . . . . . . . day of . . . . . . . . . . 20 . . . . . . . . . . Before me, Notary/Oath Commissioner Deponent's signature VERIFICATION I, the Deponent hereinabove, do hereby verify and affirm that the contents of paragraph . . . . . . to . . . . . . of this affidavit are true and correct to my knowledge and belief and no material facts have been concealed therefrom. Verified at . . . . . . . . on this . . . . . . . day of . . . . . . . 201. . . . . . Deponent's signature" 2. Substitute .....

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