FORM CA

SUBMISSION OF CLAIM BY FINANCIAL CREDITORS IN A CLASS

(Under Regulation 8Aof the Insolvency and Bankruptcy (Insolvency Resolution Process for
Corporate Persons) Regulations, 2016)

From 06-09-2019
Manjunath Yallankar
S/o Srikanth Yallankar
Aged about 33 years
2217,5th main,MCC A block,Davangere-577004
E-mail: manjunath.yallankar@gmail.com
Mob. : 9844339033
Also At
Current address to be mention if it is different from MOU address

To
XXXXXXXXXXXXXXXXX

Subject: Submission of claim and proof of claim.

Madam/Sir,

I, Manjunath Yallankar S/o: Srikanth Yallankar aged about 33 years current address to be
given 2217,5th main, MCC A block,Davangere, hereby submit this claim in respect of the
corporate insolvency resolution process of M/s.Dreamz Infra India Limited. The details for
the same are set out below:

RELEVANT PARTICULARS
1. Name of the financial creditor Manjunath Yallankar
2. Identification number of the PAN No.: AWAPM6437B
financial creditor Aadhaar No.: 937567118790
(If an incorporated body, provide
identification number and proof of
incorporation. If a partnership or
individual, provide identification
records of all the partners or the
individual)
3. Address and e-mail address of the Address for correspondence:
financial creditor for Manjunath Yallankar
correspondence. S/o Srikanth Yallankar,
Aged about 33 years
2217,5th main, MCC A block,Davangere
E-mail: manjunath.yallankar@gmail.com
Mob.: 9844339033

4. Total amount of claim (in Rs.) Rs. 1,44,000/- (One lakh forty fore thousand
 rupees only, principal amount.
5. Details of documents by reference to 1) Form CA itself,
which the debt can be substantiated 2) Claim calculation sheet.
3) Booking Form dated 08/03/2015
4) MOU dated 08.03.2015 executed between
Financial Creditor and the Corporate Debtor
confirming allotment of Flat 2 BHK
Apartments (875 sq.ft.) for Rs.13,05,000/-
(Thirteen lakhs five thousand rupees only) in
Dreamz Swadhya Project’.
5) All payment receipts issued by the Corporate
Debtor.
6) Bank Statement showing all the payments of
Rs. 1,44,000
7) Copy of PAN card of the Financial Creditor.
8) Copy of Aadhaar card of the Financial
Creditor.
9) Copy of cancelled cheque in respect of bank
account of the Financial Creditor given at Sl.
No. 9 above.
6. Details of how and when debt M/s. Dreamz Infra India Limited, the Corporate
incurred
Debtor launched Dreamz Swadhya housing
project at Doddabanahalli Village, Bidarahalli
Hobli, Bangalore East Taluk, Bangalore Urban
District. A Flat 2 BHK Apartments bearing flat as
mentioned in internal page no. 3 and 9 of MOU
dated 08/03/2015.
The said flat No. is confirmed in MOU dated
08/03/2015 executed between Financial Creditor
and the Corporate Debtor.
Details of total payments of Rs. 1,44,000/-is as
follows:
(i) Rs.1,00,000/-Through Axis bank debit card

(ii)Rs.44,000/- Through SBI bank debit card

(iii)

Total: 1,44,000/-

7. Details of any mutual credit, mutual Not Applicable

debts, or other mutual dealings
between the corporate debtor and the
creditor which may be set-off
 against the claim
8. Details of any security held, the 2 BHK Flat (875 sq. ft. for Rs.13,05,000/- ) as
value of the security, and the date it mentioned in internal page no. 3 and 7 of MOU
was given dated 08/03/2015 executed between Financial
Creditors and the Corporate Debtor. Net payment
of Rs. 1,44,000 was made by Financial
Creditor/Home Buyer.

9. Details of the bank account to which Savings Bank Account No.: ………….
the amount of the claim or any part Bank Name: …………………..
thereof can be transferred pursuant Branch: …………………..
to a resolution plan Branch Code: ……………..
IFSC Code: ……………….
10. List of documents attached to this 1) Form CA itself,
claim in order to prove the existence 2) Claim calculation sheet.
and non-payment of claim due 3) Booking Form dated 08/03/2015
4) MOU dated 08.03.2015 executed between
Financial Creditor and the Corporate Debtor
confirming allotment of Flat 2 BHK
Apartments (875sq.ft.) for Rs. 13,05,000/-
(Thirteen lakhs five thousand rupees only) in
Dreamz Swadhya Project’.
5) All payment receipts issued by the Corporate
Debtor.
6) Bank Statement showing all the payments of
Rs. 1,44,000.
7) Copy of PAN card of the Financial Creditor.
8) Copy of Aadhaar card of the Financial
Creditor.
9) Copy of cancelled cheque in respect of bank
account of the Financial Creditor given at Sl.
No. 9 above.
11. Name of the insolvency professional Xxxxxxxx
who will act as the Authorized
representative of creditors of the
class

Signature of Financial Creditor

Manjunath Yallankar

Name in BLOCK LETTERS:

Position with or in relation to creditor: Self

Address of person signing: Manjunath Yallankar

S/o Srikanth Yallankar,

Aged about 33 years

2217,5th main,MCC A block,Davangere-577004

E-mail: manjunath.yallankar@gmail.com
Mob.: 9844339033

*PAN number, passport, AADHAAR Card or the identity card issued by the Election
Commission of India.

DECLARATION
I, Manjunath Yallankar S/o: Srikanth Yallankar, 2217,5th main,MCC A block,Davangere-
577004do hereby declare and state as follows: -
1. M/s Dreamz Infra India Limited, the corporate debtor was, at the insolvency
commencement date, being the 20th August 2019, actually indebted to me for a sum
of Rs.1,44,000/-
2. In respect of myclaim of the said sum or any part thereof, I have relied on the
documents specified below:
………………..
3. The said documents are true, valid and genuine to the best of myknowledge,
information and belief and no material facts have been concealed therefrom.
4. In respect of the said sum or any part thereof, neither me, nor any person, by myorder,
to myknowledge or belief, for my use, had or received any manner of satisfaction or
security whatsoever, save and except the following:Nil
5. I am not a related party of the corporate debtor, as defined under section 5 (24) of the
Code.
6. I am eligible to give voting instruction to the authorized representative by virtue of
proviso to section 21 (2) of the Code even though I am a related party of the corporate
debtor.

Date: 06.09.2019
Place: Bengaluru
Signature of Financial Creditor

Ganesh N
VERIFICATION
I, Ganesh N S/o: Sh. Venkatesh aged about 34 years R/o. 1, Mahayogi Vemana Road, Next
to BDA Complex, Kormangala 3rd Block, Kormangala, Bengaluru-560034,the claimant
herein above, do hereby verify that the contents of this proof of claim are true and correct to
my knowledge and belief and no material fact has been concealed therefrom.

Verified at Bengaluru on this 6th of September, 2019.

Signature of Financial Creditor

Ganesh N