Schedule Form D: Corporate Persons) Regulations, 2016
Schedule Form D: Corporate Persons) Regulations, 2016
FORM D
[Date]
To
The Interim Resolution Professional / Resolution Professional
[Name of the Insolvency Resolution Professional / Resolution Professional]
[Address as set out in public announcement]
From
[Name and address of the workman / employee]
Madam/Sir,
[Name of the workman / employee], hereby submits this proof 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
DECLARATION
I, [Name of claimant], currently residing at [i nsert address] , do hereby declare and state as
follows: -
2. In respect of my claim of the said sum or any part thereof, I have relied on the
documents 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:
VERIFICATION
I, [Name] the claimant hereinabove, do hereby verify that the contents of this proof of claim
are true and correct to my knowledge and belief and no material fact has been concealed
therefrom.
(Signature of claimant).