Disclosures by Insolvency professionals in terms of IBBI Circular No. IP/005/2018 dated 16th January,2018

Name os Insolvency Professional: Test Name
Enrollment No. IP123456/11
Registration No. IP123456/11
Disclosure Purpose:

Disclosures by the Insolvency Professionals and other Professionals appointed by the
Insolvency Professionals conducting Resolution Processes of (Corporate Debtor)

Relationship with
IP/Other Professional engaged by IP Date of:
Any Appointment
Constitution of Committee of Creditor
Agreement with the Interim Finance Provider
The Supply of Information Memorandum to the Prospective Resolution Applicant
Name of Professional Professional Memebrship No. PAN IRP/RP Other Professional
(Registered Valuer/
Accountant/ Advocate/
Any other Professional)
Corporate Debtor Name of Financial Creditor Interim Financial Provider Name of Prospective Resolution Applicant Action

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Other Professional:
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Since no . of Regd .Valuers appointed are in devation with Regulation 27 read with Regulation 35 of Insolvency Resolution Regulation, 2016 ,please provide a clarification

I hereby confirm that the appointment of every other professional has been made at Arm's Length relationship in terms of Para 7 of the IBBI circular No. IP/005/2018 dated 16th January, 2018


Relationship with
IP/Other Professional engaged by IP Date of Appointment/ Constitution of Committee of Creditor/ Agreement with the Interim Finance Provider/ The Supply of Information Memorandum to the Prospective Resolution Applicant Name of Professional Professional Memebrship No. PAN IRP/RP Other Professional (Registered Valuer/ Accountant/ Advocate/ Any other Professional) Corporate Debtor Name of Financial Creditor Interim Financial Provider Name of Prospective Resolution Applicant Action

Kind: A B C D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
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Name:
Kind: A B C D
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Name:
Kind: A B C D
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Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
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Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
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Name:
Kind: A B C D
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Name:
Kind: A B C D
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Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
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Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
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Name:
Kind: A B C D
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Name:
Kind: A B C D
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Other Professional:
Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
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Name:
Kind: A B C D
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Name:
Kind: A B C D
Details
Name of Professional: Kind of Profession Date of Appointment Corporate Debtor

Disclosures by the other Professionals appointed by the
Insolvency Professionals conducting Resolution Processes

Relationship with
IP/Other Professional engaged by IP Date of:
Any Appointment
Constitution of Committee of Creditor
Agreement with the Interim Finance Provider
The Supply of Information Memorandum to the Prospective Resolution Applicant
Name of Professional Professional Memebrship No. PAN IRP/RP Other Professional (Registered Valuer/ Accountant/ Advocate/ Any other Professional) Corporate Debtor Name of Financial Creditor Interim Financial Provider Name of Prospective Resolution Applicant Action

Kind: A B C D

Name:
Kind: A B C D
Details

Kind:
A B C D

Details:

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Kind:
A B C D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details
Other Professional:
Relationship Kind:
A  B
C  D

Name:
Kind: A B C D
Details

Relationship Kind:
A  B
C  D

Details:

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

Name:
Kind: A B C D
Details

I hereby confirm that the appointment of every other professional has been made at Arm's Length relationship in terms of Para 7 of the IBBI circular No. IP/005/2018 dated 16th January, 2018