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1. Particulars of the applicant:

(i) Name of the applicant:

(ii) Address of registered office:

(iii) Address for service of all notices

2. Particulars of the defendant

(i) Name of the defendant:

(ii) Office address of the defendant

(iii) Address for service of all notices

3. Jurisdiction of the Tribunal:

The applicant declares that the subject matter of the recovery of debt due falls within the jurisdiction of the Tribunal.

4. Limitation :

The applicant further declares that the application is within the limitation prescribed in Section 24 of the Recovery of Debts to Banks and Financial Institutions Act, 1993

5. Facts of the case:

The facts of the case are given below:

(Give here a concise statement of facts in a chronological order, each paragraph containing as nearly as possible a separate issue, fact or otherwise)

6. Relief(s) sought:

In view of the facts mentioned in para 5 above, the applicant prays for the following relief(s)-

(Specify below the relief(s) sought explaining the ground for relief (s) and the legal provisions (if any) relied upon).

7. Interim order, if prayed for:

Pending final decision on the application, the applicant seeks issue of the following interim order:

(Give here the nature of the interim order prayed for with reasons).

8. Matter not pending with any other court, etc.:

The applicant. further declares that the matter regarding which the application has been made is not pending before any court of law or any other authority or any other Bench of the Tribunal.

9. Particulars of bank draft/ postal order in respect of the application fee:

(1) Name of the bank on which drawn:

(2) Demand draft no:


(1) Number of Indian Postal Order(s):

(2) Name of the issuing post office:

(3) Date of issue of postal order (s);

(4) Post office at which payable:

10. Details of index:

An index in duplicate containing the details of the documents to be relied upon is enclosed.

11. List of enclosures:


I son/ daughter/ wife of Shri ____________ being the ____________  (Name in full and block letters) (designation) of _____________  (name of the company ____________ ) holding a valid power of attorney from ____________ (name of the company ) do hereby verify that the contents of paras 1 to 11 are true to my personal knowledge and belief and that I have not suppressed any material facts.

Signature of the applicant.

Place: ____________

Date: ____________


The Registrar,







Central Bare Acts
State Bare Acts





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