The Chairperson
Insolvency and Bankruptcy Board of India

Subject: Application for Registration as an Insolvency Professional


I, having been enrolled as a Professional Member with the The Indian Institute of Insolvency professionals of ICAI hereby apply for registration as an insolvency professional under section 207 of the Insolvency and Bankruptcy Code, 2016 read with Regulation 6 of the Insolvency and Bankruptcy Board of India (Insolvency Professionals) Regulations, 2016. My details are as under:
A. Personal Details
B. Educational, Professional And Insolvency Examination Qualifications
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C. Work Experience
SL. No. From Date To date Employment / Practice If employed, Name of Employer and Designation If in practice, practice as Advocate / Chartered Accountant / Company Secretary / Cost Accountant Area Of Work
D. Insolvency Professional Agency
E. Additional Information
F. Attachments
G. Affirmations
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