SCHEDULE II

FORM G
PROOF OF CLAIM BY ANY OTHER STAKEHOLDER

(Under Regulation 20 of the Insolvency and Bankruptcy Board ofIndia (Liquidation Process)
Regulations, 2016)

April 2022

To
The Liquidator
Sunil Kumar Agrawal
Liquidator of M/s Tybros (India) Tours Pvt. Ltd.
Appointed by Hon'ble NCLT Court, New Delhi.
IBBI Regn. No. (IBBI/IPA-002/IP-N00081/2017-18/10222)

From
Anjali Chahar
PC Pratap Chowk, Gate no 3 Delhi Cantt,
New Delhi 110010
Mob

Subject: Submission of proof of claim in respect of the liquidation of M/s Tybros (India) Tours Pvt. Ltd,
First Floor, 5/54, Main Shankar Road, Old Rajendra Nagar, New Delhi- 110060 under the Insolvency and
Bankruptcy Code, 2016.

Madam/Sir,

I Sabiha Siddiqui hereby submits this proof of claim in respect of the liquidation in the case of. The details for the
same are set out below:

1.
Name of other stakeholder

(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)

2. ADDRESS AND EMAIL OF THE OTHER Pratap Chowk, Gate No 3 Delhi Cantt
STAKEHOLDER FOR CORRESPONDENCE.
New Delhi 110010
3. Principal : Rs 1,00000/-
TOTAL AMOUNT OF CLAIM, INCLUDING ANY
INTEREST AS AT LIQUIDATION CLAIM
COMMENCEMENT AND DETAILS OF
INTEREST : Rs 50000/-
NATURE OF CLAIM

Total c' : Rs 1,50000/-

DETAILS OF DOCUMENTS BY REFERENCE

4. TO WHICH THE CLAIM CAN BE

SUBSTANTIATED

5. Details of how and when claim arose Creditor was a customer to M/s Tybros (India)
Tours Pvt. Ltd booked a tour to Europe while the
Debtor and his employees were fully aware of his
non fulfillment of commitment took the bookings

6.
DETAILS OF ANY MUTUAL CREDIT, MUTUAL
DEBTS, OR OTHER MUTUAL DEALINGS
BETWEEN THE CORPORATE DEBTOR AND THE Not Applicable
OTHER STAKEHOLDER

WHICH MAY BE SET-OFF AGAINST THE CLAIM

7.
Details of any retention of title in RESPECT OF
GOODS OR PROPERTIES TO WHICH THE CLAIM
REFERS Not Applicable
 8. Details of any assignment or TRANSFER OF DEBT IN
HIS FAVOUR
Not Applicable

9.
Details of the bank account to

WHICH THE OTHER STAKEHOLDER'S SHARE OF

THE PROCEEDS OF LIQUIDATION CAN BE
TRANSFERRED

10 List out and attach the Documents relied on in support of

. the Claim.

Signature of other stakeholder or person authorised to act on his behalf (Please enclose the authority if this is being
submitted on behalf of the other stakeholder)

Name in capital Letters SABIHA SIDDIQUI

Position with or in relation to creditor Customer/Consumer

Address of person signing Pratap Chowk, Gate No 3 Delhi Cantt
New Delhi 110010

*PAN, Passport, AADHAAR Card or the identity card issued by the Election Commission of India.
PAN CARD: DDGPS1536A , ADHAAR No. 976247303382, Passport No : Z4472008, ECI ID: TSF3798212.