Download Application format insolvency professional registration in MS Word in Form-A

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:

EDUCATIONAL, PROFESSIONAL AND INSOLVENCY EXAMINATION QUALIFICATIONS

1. Educational Qualifications
[Please provide educational qualifications from Bachelor’s degree onwards]

2. Professional Qualifications

 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)

 D. INSOLVENCY PROFESSIONAL AGENCY

1. Please give details of the insolvency professional agency with which you are enrolled as a professional member.
2. Please state your professional membership number.

 E. ADDITIONAL INFORMATION

 F. ATTACHMENTS

G. AFFIRMATIONS

1. 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.
2. I am not disqualified from being registered as an insolvency professional under the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016.
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:

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