[See rule 11] STATEMENT OF FINANCIAL POSITION OF BANKRUPT [Under rule 11 of the Insolvency and Bankruptcy (Application to Adjudicating Authority for Bankruptcy Process for Personal Guarantors to Corporate Debtors) Rules, 2019] Part I RELEVANT PARTICULARS 1. Full name of bankrupt 2. Address Present Permanent Business
| 3. Bank account details (Joint and Several) | Account Number | IFSC Code Name of Bankand Bank |
Branch
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| 4. List of assets of bankrupt Immovableand immediate family as on property | Description Estimatedvalue | Excludedasset or not |
the application date for the previous three years. Note: this will include all assets of bankrupt, irrespective of them being excluded assets. Please mention the assets which may be excluded assets.
| Movableproperty | Description Estimatedvalue | Excludedasset or not |
Vehicles Shares in listed companies Shares in other companies Life insurance policy Jewellery Pension policy Investment in mutual funds Investment in other funds Investment in partnerships and other business concerns Any other property not covered above 5. The following information is required in relation to the guarantee given by the guarantor: i. Name of corporate debtor for which guarantee is given ii. Any current or past position held in the corporate debtor iii. Whether corporate debtor is an associate iv. Any securities held in corporate debtor for whom guarantee is given
6. Name and address of person resident in India authorised to accept the service of process on bankrupt’s behalf (if applicable) Part II FINANCIAL INFORMATION 1. Statement of assets and liabilities for the previous three years 2. Secured and unsecured debts, with complete details of the creditors including name and postal address, the total amount due, amount in default and details of the security, for the previous three years 3. Details of the debts owed to associates of the bankrupt, for the previous three years 4. Details of guarantees given in relation to any of the debts of the guarantor, and if any of the guarantors is an associate of the guarantor 5. Details of the business owned by the bankrupt, or of the firm in which the bankrupt is a partner, as the case may be, for the previous three years, if applicable 6. Details of the wealth tax statements filed by the bankrupt, if any, for the previous five years. 7. Details of trusts held by bankrupt and/or immediate family of bankrupt 8. Any other relevant information