SCHEDULE FORM B - Jaypee Group

1 SCHEDULEFORM BPROOF OF CLAIM BY OPERATIONAL CREDITORS EXCEPT WORKMEN AND EMPLOYEES[Under Regulation 7 of the insolvency and bankruptcy board of India ( insolvency Resolution Processfor Corporate Persons) Regulations, 2016][Date]ToThe Interim Resolution Professional/ Resolution Professional[Name of the insolvency Resolution Professional/ Resolution Professional][Address as set out in public announcement]From[Name and address of the operational creditor]Subject: Submission of proof of ,[Name of the operational creditor], hereby submits this proof of claims in respect of the corporateinsolvency resolution process in the case of [name of corporate debtor].

2 The details for the same areset out OF OPERATIONAL CREDITOR NUMBER OF OPERATIONALCREDITOR(IF AN INCORPORATED BODY PROVIDEIDENTIFICATION NUMBER AND PROOF OFINCORPORATION. IF A PARTNERSHIP ORINDIVIDUAL PROVIDE IDENTIFICATIONRECORDS* OF ALL THE PARTNERS OR THEINDIVIDUAL) AND EMAIL ADDRESS OFOPERATIONAL CREDITOR AMOUNT OF CLAIM(INCLUDING ANY INTEREST AS AT THEINSOLVENCY COMMENCEMENT DATE) OF DOCUMENTS BY REFERENCE TOWHICH THE DEBIT CAN BE OF ANY DISPUTE AS WELL AS THERECORD OF PENDENCY OR ORDER OF SUITOR ARBITRATION PROCEEDINGS OF HOW AND WHEN OF ANY MUTUAL CREDIT.

3 MUTUALDEBIT OR OTHER MUTUAL DEALINGSBETWEEN THE CORPPORATE DEBIT AND THECREDITOR WHICH MAY BE SET OFF AGAINSTTHE OF ANY RETENTION OF TITLEARRANGEMENTS IN RESPECT OF GOODS ORPROPERTIES TO WHICH THE CLAIM OF THE BANK ACCOUNT TO WHICHTHE AMOUNT OF THE CLAIM OR ANY PARTTHEREOF CAN BE TRANSFERED PURSUANTTO A RESOLUTION OF DOCUMENTS ATTACHED TO THISPROOF OF CLAIM IN ORDER TO PROVE THEEXISTENCE AND NON PAYMENT OF CLAIMDUE TO THE OPERATIONAL CREDITOR Signature of operational creditor or person authorised to act on his behalf[Please enclose the authority if this is being submitted on behalf of an operational creditor] Name in BLOCK LETTERSP osition with or in relation to creditorAddress of person signing*PAN number, passport, AADHAR Card or identity card issued by the Election Commission of IndiaAFFIDAVIT I, [name of deponent], currently residing at [insert address], do solemnly affirm and state asfollows: 1.

4 [Name of corporate debtor], the corporate debtor was, at the insolvency commencement date,being the _____day of _____20__, justly and truly indebted to me in the sum of Rs.[insertamount of claim]. respect of my claim of the said sum or any part thereof, I have relied on the documentsspecified below:[Please list the documents related on as evidence of claim] said documents are true, valid and genuine to the best of my knowledge, information respect of the said sum or any part thereof, I have not nor has any person, by my order, tomy knowledge or belief, for my use, had or received any manner of satisfaction or securitywhatsoever, save and except the following.

5 [Please state details of any mutual credit, mutual debts, or other mutual dealings between thecorporate debtor and the creditor which may be set-off against the claim.] Solemnly, affirmed at [insert place] on _____ day, the _____ day of _____ 20 _____ Before me, Notary/ Oath CommissionerDeponent s signatureVERIFICATION I, the Deponent hereinabove, do hereby verify and affirm that the contents of paragraph ___ to ___ ofthis affidavit are true and correct to my knowledge and belief and no material facts have beenconcealed at _____ on this ____ day of _____ 201_Deponent s signatur