APPLICATION FORM FOR ENLISTING OF RESOLUTION AGENT

A) APPLICANT’S BASIC INFORMATION

1 NAME
2 CONSTITUTION Individual / proprietorship concern /
(Copies of by-laws/memorandum and articles of partnership firm / private / public limited
association as applicable to be enclosed) company
3 Date of __/__/____ 4. Date of __/__/____ 5. E-mail
Registration/ commencement
incorporation of business
6 Principal Person Land
Line/Call/Fax
Numbers

7 Contact Person Land

Line/Call/Fax
Numbers

8 Details of registered office, administrative office and Branches, if any

Location Address Telephone Fax Number
Number

9 Brief Particulars of activities carried out by the firm/company

B) APPLICANT’S KNOWLEDGE RESOURCES

1) Personal & Professional details of Promoter/Partner/Directors
S.No. Name Designation Date of Qualification Experience
Birth
 2) Personal & Professional details of Professional staff (part/full time)
S.No. Name Designation Date of Qualification Experience
Birth

3) Professional Credentials
a) Whether empanelled with other bank/Financial Copies of letters of empanelment to be
Institution? attached
b) Membership/registration with
national/international institutes/agencies

4) Important assignments handled

I/we shall glad if bank select me/us as resolution agent. I/we confirm that the information furnished above
is true and correct and I undertake to abide by the Bank’s rules and guidelines in this regard.

Place:

Date: Signature:
Name:

*Please attach a separate sheet if space is insufficient and also your detailed Profile.