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    Jayakrushna Palei: Saving Bank Account

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    beheradharmendra44
    1. Jayakrushna Palei submits a claim of Rs. 150,000 against Alchemist Infra Realty Limited, which is undergoing corporate insolvency resolution. 2. The debt was incurred on 09/06/2012 for cash. No security or mutual credit/debts exist between the parties. 3. Documents including Aadhar card, voter ID, bank passbook and allotment papers are attached to prove the existence and non-payment of the debt.

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    Jayakrushna Palei: Saving Bank Account

    Uploaded by

    beheradharmendra44
    7 views2 pages
    1. Jayakrushna Palei submits a claim of Rs. 150,000 against Alchemist Infra Realty Limited, which is undergoing corporate insolvency resolution. 2. The debt was incurred on 09/06/2012 for cash. No security or mutual credit/debts exist between the parties. 3. Documents including Aadhar card, voter ID, bank passbook and allotment papers are attached to prove the existence and non-payment of the debt.

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    1. Jayakrushna Palei submits a claim of Rs. 150,000 against Alchemist Infra Realty Limited, which is undergoing corporate insolvency resolution. 2. The debt was incurred on 09/06/2012 for cash. No security or mutual credit/debts exist between the parties. 3. Documents including Aadhar card, voter ID, bank passbook and allotment papers are attached to prove the existence and non-payment of the debt.

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    7 views2 pages

    Jayakrushna Palei: Saving Bank Account

    Uploaded by

    beheradharmendra44
    1. Jayakrushna Palei submits a claim of Rs. 150,000 against Alchemist Infra Realty Limited, which is undergoing corporate insolvency resolution. 2. The debt was incurred on 09/06/2012 for cash. No security or mutual credit/debts exist between the parties. 3. Documents including Aadhar card, voter ID, bank passbook and allotment papers are attached to prove the existence and non-payment of the debt.

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    of 2

    FORM CA

    SUBMISSION OF CLAIM BY FINANCIAL CREDITORS IN A CLASS


    (Under Regulation 8Aof the Insolvency and Bankruptcy (Insolvency Resolution Process for Corporate Persons)
    Regulations, 2016)
    [Date]
    From
    [Name and address of the financial creditor, including address of its registered office and principal office]

    To
    The Interim Resolution Professional
    Gaurav Misra
    510, Fifth Floor, Tower -1,
    Assotech Business Cresterra,
    Sector -135, Noida, UP 201305

    Subject: Submission of claim and proof of claim.

    Madam/Sir,

    , hereby submits this claim in respect of the corporate insolvency resolution process of Alchemist Infra Realty
    Limited. The details for the same are set out below:
    RELEVANT PARTICULARS
    1. Name of the financial creditor JAYAKRUSHNA PALEI
    2. Identification number of the financial creditor Aadhar
    (If an incorporated body, provide identification number and proof of No-554902246535
    incorporation. If a partnership or individual, provide identification Voter ID
    records of all the partners or the individual) No-OR/08/057/048255
    3. Address and e-mail address of the financial creditor for At-Titip,Po-Krushnaprasad,,Dist-
    correspondence. Puri,(Odisha)
    PIN-752011
    [email protected]
    4. Total amount of claim (in Rs.) 150000
    5. Details of documents by reference to which the debt can be Certificate No-RD00748352
    substantiated Allotmen No-RD00759750
    6. Details of how and when debt incurred Cash 09/06/2012
    7. Details of any mutual credit, mutual debts, or other mutual dealings No
    between the corporate debtor and the creditor which may be set-off
    against the claim
    8. Details of any security held, the value of the security, and the date it No
    was given
    9. Details of the bank account to which the amount of the claim or any JAYAKRUSHNA PALEI
    part thereof can be transferred pursuant to a resolution plan ODISHA GRAMYA BANK
    Ch Nuapada branch
    A/C No-002801000021956
    IFSC Code-IOBA0ROGB01
    Saving Bank Account

    10. List of documents attached to this claim in order to prove the Alchemist infra
    existence and non-payment of claim due realty limited(1),
    Aadhar card copy
    Voter ID copy &
    Bank passbook copy

    11. Name of the insolvency professional who will act as the Authorised Rakesh verma
    representative of creditors of the class
    Signature of financial creditor or person authorised to act on its behalf
    [Please enclose the authority if this is being submitted on behalf of the financial creditor]

    Name in BLOCK LETTERS : JAYAKRUSHNA PALEI

    Position with or in relation to creditor : Self

    Address of person signing : At-Titip,Po-Krushnaprasad,Dist- Puri,(Odisha)PIN-752011

    *PAN number, passport, AADHAAR Card or the identity card issued by the Election Commission of India.

    DECLARATION

    I, [JAYAKRUSHNA PALEI], currently residing At-Titip,Po-Krushnaprasad,Dist- Puri,(Odisha)PIN-752011

    ], do hereby declare and state as follows: -


    1. Alchemist Infra Realty Limited, the corporate debtor was, at the insolvency commencement
    date, being the05rdday of Mar 2022, actually indebted to me for a sum of Rs.

    2. In respect of my claim of the said sum or any part thereof, I have relied on the documents specified
    below: [Aadhar card copy, Voter ID copy & Bank passbook].
    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
    debtorand the creditor which may be set-off against the claim].
    5. I am / I am not a related party of the corporate debtor, as defined under section 5 (24) of the Code.
    6. I am eligible to give voting instruction to the authorized representative by virtue of proviso to
    section 21 (2) of the Code even though I am a related party of the corporate debtor.

    Date:05/06/2022
    Place:MALUD
    (Signature of the claimant)
    VERIFICATION
    I, [JAYAKRUSHNA PALEI] 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.

    Verified at … on this …… day of ………., 20…


    (Signature of claimant)
    [Note: In the case of company or limited liability partnership, the declaration and verification shall be made by
    the director/manager/secretary/designated partner and in the case of other entities, an officer authorized for the
    purpose by the entity.]

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