MSME Recovery Application Form
Section A - Seller (MSME) Details
Name of MSME (Seller): _________________________________
Legal Entity Type (Proprietorship/Partnership/LLP/Company): _________________________________
Authorized Person Name: _________________________________
Contact Number: _________________________________
Email ID: _________________________________
PAN Number: _________________________________
GST Number: _________________________________
Udyam Registration Number: _________________________________
Registered Business Address: _________________________________
Section B - Buyer Details
Name of Buyer: _________________________________
Legal Entity Type (Proprietorship/Partnership/LLP/Company): _________________________________
Authorized Person Name: _________________________________
Contact Number: _________________________________
Email ID: _________________________________
PAN Number: _________________________________
GST Number: _________________________________
Business Address: _________________________________
Section C - Transaction & Dues Details
Total Principal Amount Due (Rs.): _________________________________
Interest Claimed (if any) - as per invoice or @18%: _________________________________
Total Outstanding Amount (Rs.): _________________________________
No. of Invoices Raised: _________________________________
Period of Supply (From - To): _________________________________
Purchase Order / Agreement Available (Yes/No): _________________________________
Brief Description of Goods/Services Supplied: _________________________________
Section D - Supporting Documents Checklist
[ ] Udyam Registration Certificate
[ ] PAN Card (Both Parties)
[ ] GST Certificate (Both Parties)
[ ] Invoice(s)
[ ] Ledger of Outstanding
[ ] Purchase Order / Work Order (if available)
[ ] Affidavit (if PO not available)
[ ] Communication Proof (Emails/WhatsApp)
[ ] Bank Statement (optional)