TMI BlogApplication for registration as an insolvency professional - Regulation 6- Insolvency ProfessionalsX X X X Extracts X X X X X X X X Extracts X X X X ..... ia (Insolvency Professionals) Regulations, 2016. My details are as under: A. PERSONAL DETAILS 1. Title (Mr. / Mrs. / Ms. / Other): 2. Name (as per PAN / Aadhaar): 3. Father s Name: 4. Mother s Name: 5. Date of Birth: 6. Place of Birth: 7. PAN: 8. AADHAAR No. (if available): 9. Passport No. (if available): 10. GSTIN (if available): 11. DIN / DPIN (if available): 12. Address for Correspondence (Note: This shall be recorded as the registered address) : 13. Permanent Address: 14. E-mail Address (Note: This shall be recorded as the registered e-mail address) : 15. Mobile No. (Note: This shall be recorded as the registered mobile number) : 16. Residential Status: Person resident in India/ Person resident outside India (strike off whichever is not applicable) [in terms of section 3 (24) or 3 (25) of Insolvency and Bankruptcy Code, 2016] B. EDUCATIONAL, PROFESSIONAL AND INSOLVENCY EXAMINATION QUALIFICATIONS (i) Educational Qualifications [Please provide educational qualifications from Bachelor s degree onwards] Sl. No. Educational qualification University ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 3 National Insolvency Programme (iv) Are you a registered valuer? (Yes/No) If yes, (a) IBBI Registration No._______________ (b) Name of Registered Valuer Organisation (RVO) ______________and, (c) RVO Enrolment No.________________ C. WORK EXPERIENCE (i) Are you presently in practice / employment? (Practice / Employment) (ii) Total period in practice (years and completed months): yy / mm (iii) Total period in employment (years and completed months): yy / mm (iv) Details of experience (from the date of enrolment as an Advocate / Chartered Accountant/ Company Secretary / Cost Accountant / After Bachelors Degree / After Master Degree / After Post Graduate Diploma) SI. No. From Date (dd-mmyyyy ) To Date (dd-mmyyyy) Employment Practice Area of Work Name and Address of Employer Designation Advocate/ CA/CS/CM ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... as (i) a chartered accountant registered with the Institute of Chartered Accountants of India; (ii) a company secretary registered with the Institute of Company Secretaries of India; (iii) a cost accountant registered with the Institute of Cost Accountants of India; or (iv) an advocate enrolled with the Bar Council. 7. Copies of certificate of employment from the employer(s), specifying the period of such employment 8. Financial statements / Income-tax Returns for the last three years. 9. Copy of certificate of professional membership of Registered Valuer Organisation. 10. Evidence of deposit / payment of applicable fee. 11. Details of information with respect to conviction, criminal proceedings, insolvency/bankruptcy order, disciplinary proceedings/actions, and any other additional information relevant for the application, as may be applicable (including brief facts, copy of relevant orders and present status thereof) as separate enclosures. F. UNDERSTANDING I understand and agree that my enrolment with the and completion of preregistration educational course, subsequently, does not entitle me to the registration, which is subject to me complyi ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... cation is correct and complete to the best of my knowledge and belief. 3. I undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016, rules, regulations, guidelines and circulars issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled and directions given by the Board and the Governing Board of such insolvency professional agency and to furnish any additional information as and when called for by the Board or Insolvency Professional Agency. F. ATTACHMENTS 1. Copy of certificate of membership with an insolvency professional agency. 2. Copy of certificate of completion of pre-registration educational course. 3. Evidence of deposit / payment of applicable fee. 4. Copy of proof towards information updated in the Form A, wherever applicable. Name and signature of applicant Place: Date: Part - III TO BE SUBMITTED BY THE INSOLVENCY PROFESSIONAL AGENCY [For the purposes of registration as an Insolvency Professional] To, The Executive Director (IP Division) Insolvency and Bankruptcy Board of India Subject: Application for registration as an insolvency profess ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Yes, give details and supporting document. 7 In case, DIN / DPIN has been furnished by the professional member, whether the status thereof has been verified along with nature of designation held by the professional member? Yes / No. If Yes, give details and supporting document. 8 Whether the name of the professional member appears in the database of Ministry of Corporate Affairs regarding: i. Directors disqualified under section 164 of the Companies Act, 2013, or ii. Proclaimed Offenders under section 82 of the Code of Criminal Procedure, 1973. Yes / No. If Yes, give details and supporting document. 9 Whether the professional member has been penalised by SEBI or CCI in the last three years? Yes / No. If Yes, give details and supporting document. 10 Whether the name of professional member appears in the list of defaulters of RBI / Credit Information Company? Yes / No. If Yes, give details and supporting document. ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... onal Qualification Institute/Professional Body Membership No. (if applicable) Date of enrolment Remarks, if any 3. Insolvency Qualifications 3.1. Have you passed Limited Insolvency Examination? (Yes/No) 3.2. Have you passed National Insolvency Examination? (Yes/No) C. WORK EXPERIENCE 1. Are you presently in practice/employment? (Yes/No) 2. Number of years in practice (in years and months): 3. If in practice, address for professional correspondence: 4. Number of years in employment (in years and months): 5. Experience Details (from the date of enrolment as Advocate/Chartered Accountant/Company Secretary/Cost Accountant/Bachelors' Degree) Sl.No. From Date To Date Employment/Practice If employed, Name of Employer and Designation If in practice, practice as Advocate/Chartered Accountant/Company Secretary/Cost Accountant Area of work ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 3. This application and the information furnished by me along with this application is true and complete. If found false or misleading at any stage, my registration/ registration for limited period shall be summarily cancelled. 4. I hereby undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016, the rules, regulations and guidelines issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled, and the resolutions passed and directions given by the Board and the Governing Board of such insolvency professional agency. 5. The applicable fee has been paid. Name and Signature of applicant Place: Date: ______________________________________________ VERIFICATION BY THE INSOLVENCY PROFESSIONAL AGENCY We have verified the above details submitted by who is our professional member with professional membership no. and confirm these to be true and correct. We recommend registration of as an insolvency professional. (Name and Signature) Authorised Representative of the Insolvency Professional Agency Seal of the Insolvency Professional Agency Place: Date: 2. Substituted vide N ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... / No) 3.3. Have you successfully completed the Graduate Insolvency Programme? (Yes / No) 3.4. Have you completed the pre-registration training with an insolvency professional agency? (Yes / No) C. WORK EXPERIENCE 1. Are you presently in practice / employment? (Yes/ No) 2. Number of years in practice (in years and months): 3. If in practice, address for professional correspondence: 4. Number of years in employment (in years and months): 5. Experience Details (from the date of enrolment as Advocate / Chartered Accountant / Company Secretary / Cost Accountant/ Bachelors Degree) Sl. No. From Date To Date Employment / Practice If employed, Name of Employer and Designation If in practice, practice as Advocate / Chartered Accountant / Company Secretary / Cost Accountant Area of work ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... urnished by me along with this application is true and complete. If found false or misleading at any stage, my registration shall be summarily cancelled. 5. I hereby undertake to comply with the requirements of the Insolvency and Bankruptcy Code, 2016 , the rules, regulations, guidelines and circulars issued thereunder, the bye-laws of the insolvency professional agency with which I am enrolled, and the resolutions passed and directions given by the Board and the Governing Board of such insolvency professional agency. 6. The applicable fee has been paid. Name and Signature of applicant Place: Date: VERIFICATION BY THE INSOLVENCY PROFESSIONAL AGENCY We have verified as under: Verification Finding Whether any disciplinary proceedings are pending or any disciplinary action has been taken at any time in the preceding three years against the professional member by the ICAI, ICSI, ICAI(Cost), or Bar Council, of which he is a Member. Yes / No. If Yes, give details. If required, attach additional papers Whether a regulator ICAI, ICAI (Cost), ICSI, or Bar Counci ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... number], hereby apply for registration as an insolvency professional under section 207 of the Insolvency and Bankruptcy Code, 2016 read with regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016 [IP Regulations]. My details are as under: A. PERSONAL DETAILS 1. Title (Mr. / Mrs. / Ms. / Other): 2. Name (as per PAN / Aadhaar): 3. Father s Name: 4. Mother s Name: 5. Date of Birth: 6. Place of Birth: 7. PAN: 8. AADHAAR No. (if available): 9. Passport No. (if available): 10. GSTIN (if available): 11. DIN / DPIN (if available): 12. Address for Correspondence (Note: This shall be recorded as the registered address): 13. Permanent Address: 14. E-mail Address (Note: This shall be recorded as the registered e-mail address): 15. Mobile No. (Note: This shall be recorded as the registered mobile number): 16. Residential Status: Person resident in India/ Person resident outside India (strike off whichever is not applicable) [in terms of section 3 (24) or 3 (25) of Insolvency and Bankruptcy Code, 2016] B. QUALIFICATIONS: EDUCATIONAL, PROFESSIONAL, INSOLVENCY EXAMINATION A ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... (iv) Pre-Registration Educational Course: Have you completed the Pre-Registration Educational Course? (Yes/No) If Yes, date of completion of Pre-Registration Educational Course: dd/mm/yyyy (v) Are you a registered valuer? (Yes/No) If yes, (a) IBBI Registration No. ___________, (b) Name of Registered Valuer Organisation (RVO) ____________ and, (c) RVO enrollment No. ___________. C. WORK EXPERIENCE (i) Are you presently in practice / employment? (Practice / Employment) (ii) Total period in practice (years and completed months): yy / mm (iii) Total period in employment (years and completed months): yy / mm (iv) Details of experience (from the date of enrolment as an Advocate / Chartered Accountant / Company Secretary / Cost Accountant /after Bachelors Degree) Sl. No. From ( dd-mm-yyyy ) To ( dd-mm-yyyy ) Employment Practice Area of work Name and Address of Employer ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Date: ATTACHMENTS 1. Copy of proof of residence 2. Copy of PAN card, Aadhaar card and Passport 3. Copy of GST Registration Certificate 4. Copy of DIN/DPIN allotment letter 5. Copies of documents in support of educational qualification, professional qualification and insolvency examination and completion of Pre-Registration Education Course 6. Copies of documents demonstrating practice as - (i) a chartered accountant registered with the Institute of Chartered Accountants of India; (ii) a company secretary registered with the Institute of Company Secretaries of India; (iii) a cost accountant registered with the Institute of Cost Accountants of India; or (iv) an advocate enrolled with the Bar Council. 7. Copies of certificate of employment from the employer(s), specifying the period of such employment 8. Financial statements / Income-tax Returns for the last three years. 9. Copy of certificate of professional membership with an insolvency professional agency and /or Registered Valuer Organisation 10. Evidence of deposit / payment of fee, along with GST, as required under regulation 6(1) of IP Regulations 11.Details of infor ..... X X X X Extracts X X X X X X X X Extracts X X X X
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