Download Application format insolvency professional registration in MS Word in Form-A under Insolvency and Bankruptcy Board of India Regulations 2016
FORM A
[Under Regulation 6 or Regulation 9 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016]
To
The Chairperson
Insolvency and Bankruptcy Board of India
Subject: Application for registration as an insolvency professional / insolvency professional for limited period
Sir/Madam,
I, having been enrolled as a professional member with the (please write the name of the insolvency professional agency), hereby apply for registration as
(a) an insolvency professional /
(b) an insolvency professional for limited period (strike off which is not applicable) under section 207 of the Insolvency and Bankruptcy Code, 2016 read with Regulation 6 or Regulation 9 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. My details are as under:
A |
PERSONAL DETAILS | |
1. Title (Mr/Mrs/Ms): | ||
2. Name: | ||
3. Father’s Name: | ||
4. Date of Birth: | ||
5. Place of Birth: | ||
6. PAN No.: | ||
7. AADHAAR No.: | ||
8. Passport No.: | ||
9. Address for Correspondence: | ||
10. Permanent Address: | ||
11. E-Mail Address: | ||
12. Mobile No.: |
EDUCATIONAL, PROFESSIONAL AND INSOLVENCY EXAMINATION QUALIFICATIONS
1. Educational Qualifications
[Please provide educational qualifications from Bachelor’s degree onwards]
Educational Qualification | Year of Passing | Marks (%) | Grade/ Class | University/ College |
Remarks, if any |
2. Professional Qualifications
Professional 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
- Are you presently in practice / employment? (Yes/ No)
- Number of years in practice (in years and months):
- If in practice, address for professional correspondence:
- Number of years in employment (in years and months):
- 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 |
D. INSOLVENCY PROFESSIONAL AGENCY
- Please give details of the insolvency professional agency with which you are enrolled as a professional member.
- Please state your professional membership number.
E. ADDITIONAL INFORMATION
1. Have you ever been convicted for an offence? Yes/ No. If yes, please give details. | |
2. Are any criminal proceedings pending against you? (Yes/ No) If yes, please give details. | |
3. Have you ever been declared as an undischarged insolvent, or applied to be declared so? (Yes/ No) If yes, please give details. | |
4. Please provide any additional information that may be relevant for your application. |
F. ATTACHMENTS
1. Copy of proof of residence. | |
2. Copies of documents in support of educational qualifications, professional qualification and insolvency examination qualifications. |
|
3. Copies of documents demonstrating practice as –
i. a chartered accountant enrolled with the Institute of Chartered Accountants of India; ii. a company secretary enrolled with the Institute of Company Secretaries of India; iii. a cost accountant enrolled with the Institute of Cost Accountants of India; or iv. an advocate enrolled with the Bar Council of any State in India; |
|
4. Copies of certificate of employment from the employer(s), specifying the period of such employment. |
|
5. Financial statement / Income Tax Returns for the last three years. |
|
6. Copy of certificate of professional membership with an insolvency professional agency. |
|
7. Passport-size photo. |
|
8. Evidence of deposit / payment of five thousand rupees / ten thousand rupees, as applicable. |
G. AFFIRMATIONS
- Copies of documents, as listed in section F of this application form have been attached/ uploaded. The documents attached/ uploaded are …… I undertake to furnish any additional information as and when called for.
- I am not disqualified from being registered as an insolvency professional under the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016.
- 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.
- 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.
- 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:
Download Format of Application for registration as an insolvency professional in MS Word Click Here >>
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