Official Form 401 Chapter 15 Petition for Recognition of a Foreign Proceeding page 1 

Official Form 401 

Chapter 15 Petition for Recognition of a Foreign Proceeding 12/15

If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write debtor’s name and case number (if known). 

1. Debtor’s name _____________________________________________________________________________________________ 

2. Debtor’s unique identifier 

 

For non-individual debtors: 

 Federal Employer Identification Number (EIN) ___ ___ – ___ ___ ___ ___ ___ ___ ___ 

 Other ___________________________. Describe identifier _____________________________. 

For individual debtors: 

 Social Security number: xxx – xx– ____ ____ ____ ____ 

 Individual Taxpayer Identification number (ITIN): 9 xx – xx – ____ ____ ____ ____ 

 Other ___________________________. Describe identifier ______________________________. 

3. Name of foreign 

representative(s) ____________________________________________________________________________________________ 

4. Foreign proceeding in which 

appointment of the foreign 

representative(s) occurred 

____________________________________________________________________________________________ 

5. Nature of the foreign 

proceeding Check one: 

 Foreign main proceeding 

 Foreign nonmain proceeding

 Foreign main proceeding, or in the alternative foreign nonmain proceeding

6. Evidence of the foreign 

proceeding 

 A certified copy, translated into English, of the decision commencing the foreign proceeding and 

appointing the foreign representative is attached. 

 A certificate, translated into English, from the foreign court, affirming the existence of the foreign 

proceeding and of the appointment of the foreign representative, is attached. 

 Other evidence of the existence of the foreign proceeding and of the appointment of the foreign 

representative is described below, and relevant documentation, translated into English, is attached. 

 _______________________________________________________________________________________ 

 _______________________________________________________________________________________ 

7. Is this the only foreign 

proceeding with respect to 

the debtor known to the 

foreign representative(s)? 

 No. (Attach a statement identifying each country in which a foreign proceeding by, regarding, or against the 

debtor is pending.) 

 Yes

United States Bankruptcy Court for the: 

__________ District of __________ 

Case number (If known): _________________________ Chapter 15 

Fill in this information to identify the case: 

 Check if this is an 

amended filing

Southern District of Florida

Performance Insurance Company SPC

✔ 307829 ROC registration number

Kenneth Krys & Neil Dempsey

Cayman Islands

✔

✔

Resolutions by the Debtor's sole shareholder

Resolutions by the Debtor's directors

✔

Case 21-12609-AJC Doc 1 Filed 03/19/21 Page 1 of 3
Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

 Official Form 401 Chapter 15 Petition for Recognition of a Foreign Proceeding page 2 

8. Others entitled to notice Attach a list containing the names and addresses of: 

(i) all persons or bodies authorized to administer foreign proceedings of the debtor, 

(ii) all parties to litigation pending in the United States in which the debtor is a party at the time of filing of this 

petition, and 

(iii) all entities against whom provisional relief is being sought under § 1519 of the Bankruptcy Code.

9. Addresses Country where the debtor has the center of its 

main interests: 

______________________________________________ 

Debtor’s registered office: 

______________________________________________

Number Street 

_______________________________________________ 

P.O. Box 

_______________________________________________ 

City State/Province/Region ZIP/Postal Code 

_______________________________________________

Country 

Individual debtor’s habitual residence: 

_______________________________________________ 

Number Street 

_______________________________________________ 

P.O. Box 

_______________________________________________ 

City State/Province/Region ZIP/Postal Code 

_______________________________________________ 

Country

Address of foreign representative(s):

_______________________________________________ 

Number Street 

_______________________________________________ 

P.O. Box 

_______________________________________________ 

City State/Province/Region ZIP/Postal Code 

_______________________________________________ 

Country

10. Debtor’s website (URL) ____________________________________________________________________________________________________ 

11. Type of debtor Check one: 

 Non-individual (check one): 

 Corporation. Attach a corporate ownership statement containing the information 

described in Fed. R. Bankr. P. 7007.1. 

 Partnership

 Other. Specify: ________________________________________________ 

 Individual

Kynect Risk Management Limited

Performance Insurance Company SPC

Cayman Islands P.O. Box 445, 3rd Floor Bayshore Centre

31 Warwick Road, George Town

Grand Cayman KY1-1106

Cayman Islands

Governors Square, Bldg. 3, Ground Floor

23 Lime Tree Bay Avenue, PO Box 31237

Grand Cayman KY1-1025

Cayman Islands

✔ Segregated Portfolio Company

Case 21-12609-AJC Doc 1 Filed 03/19/21 Page 2 of 3
Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

 Official Form 401 Chapter 15 Petition for Recognition of a Foreign Proceeding page 3 

12. Why is venue proper in this 

district?

Check one:

 Debtor’s principal place of business or principal assets in the United States are in this district. 

 Debtor does not have a place of business or assets in the United States, but the following 

action or proceeding in a federal or state court is pending against the debtor in this district:

___________________________________________________________________________.

 If neither box is checked, venue is consistent with the interests of justice and the convenience 

of the parties, having regard to the relief sought by the foreign representative, because: 

___________________________________________________________________________. 

13. Signature of foreign 

representative(s) I request relief in accordance with chapter 15 of title 11, United States Code. 

I am the foreign representative of a debtor in a foreign proceeding, the debtor is eligible for the 

relief sought in this petition, and I am authorized to file this petition. 

I have examined the information in this petition and have a reasonable belief that the 

information is true and correct. 

I declare under penalty of perjury that the foregoing is true and correct, 

8________________________________________________ _______________________________________________ 

Signature of foreign representative Printed name 

Executed on __________________ 

 MM / DD / YYYY

8________________________________________________ _______________________________________________ 

Signature of foreign representative Printed name 

Executed on __________________ 

 MM / DD / YYYY

14. Signature of attorney 8_________________________________________________ Date _________________

Signature of Attorney for foreign representative MM / DD / YYYY 

_________________________________________________________________________________________________ 

Printed name 

_________________________________________________________________________________________________ 

Firm name 

_________________________________________________________________________________________________ 

Number Street 

____________________________________________________ __________________________________________ 

City State ZIP Code 

____________________________________ __________________________________________ 

Contact phone Email address 

______________________________________________________ ____________ 

Bar number State 

Performance Insurance Company SPC

✔

Kenneth Krys

03/19/2021

Neil Dempsey

03/19/2021

03/19/2021

 Gregory S. Grossman

 Sequor Law, P.A.

 1111 Brickell Avenue, Suite 1250

 Miami FL 33131

(305) 372-8282 ggrossman@sequorlaw.com

896667 FL

Case 21-12609-AJC Doc 1 Filed 03/19/21 Page 3 of 3