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Application for recognition as an insolvency professional entity- Regulation 12-Insolvency Professionals

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..... r recognition as an insolvency professional entity under sub-regulation (2) of regulation 12 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. The details of the applicant and its directors / partners are as under: A. DETAILS OF APPLICANT 1. Name: 2. Address: i. registered office: ii. principal place(s) of business, if any: iii. Address for Correspondence with the Applicant iv. E-mail address for correspondence with the Applicant: v. Telephone number for correspondence with the Applicant: 3. Nature of constitution: Company /Limited Liability Partnership/ Reg .....

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..... (2) (3) (4) (5) (6) (7) (8) (9) C. ELIGIBILITY [in terms of Regulation 12 (1) of IP Regulati .....

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..... (ii) In case of Company Sl. No. .....

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..... (Yes/No) If yes, please furnish the date of derecognition and ground for derecognition. 6. Whether any disciplinary proceeding has been initiated by the Board (IBBI) or the Insolvency Professional Agency against any director(s) / partner(s), who was/is/are insolvency professional(s). (Yes/No) If yes, please provide details. AFFIRMATION I, on behalf of [name of the applicant entity], affirm that - (i) the applicant is eligible to be recognised as an insolvency professional entity; (ii) none of the directors or partners of the applicant, as the case may be, is a director or partner of another insolvency professional entity. 2. I affirm t .....

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..... may be, of applicant 9. Evidence of deposit / payment of fee, along with GST, as required under regulation 12(2) of IP Regulations. ] *********** NOTES:- 1. Substituted vide Notification No. IBBI/2019-20/GN/REG049 dated 25-10-2019 before it was read as FORM C [Under Regulation 12 of the Insolvency and Bankruptcy Board of India ( Insolvency Professionals ) Regulations, 2016] To The Chairperson Insolvency and Bankruptcy Board of India Sub.: Application for recognition as an insolvency professional entity Sir/Madam, 1. I, being duly authorized for the purpose, hereby apply on behalf of [name and address of the applicant] for recognition as an insolvency professiona .....

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..... on authorized to make this application and correspond with the Board in this respect: PART II DIRECTORS/ PARTNERS 1. Please state the details of all directors/ partners of the applicant: Sl.No. Name and address of the director/ partner DIN PAN Registration No. as an insolvency professional Professional membership No. Yours faithfully, Authorized Signatory (Name) (Designation) Place : Date : - Forms Tax Management India - taxmanagementindia - taxmanagement - taxmanagementindi .....

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