4.

Whether

Belongs

to   Yes / No

SC/ST/OBC/Minority Community

If Yes, then Please Select: SC/ ST/

OBC/ Minority Community

14

Name of Proprietors/ Partners/ Directors of Company and Their Addresses:

S.No

Name

Date

Father/

Academic

Mobile

PAN

Res.

Tel

Experience

of

Spouse

Qualification

No

No.

Address

No.

in the line

Birth

(Res.)

of activity

(i)

(ii)

(iii)

(iv)

(v)

15

Activity

Existing _______ since _________

Proposed# _________

#if a different activity other than existing activity is proposed.

16.

Names of Associate Concerns and Nature of Association

Sl.

Name of Associate

Address of

Presently

Nature of

Extent of

No.

Concerns

Associate

Banking With

Association

Interest as a

Concerns

Prop./ Partner/

Director or Just

Investor in

Associate

Concern

(i)

(ii)

(iii)

(iv)

(v)

Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of the Bank:

Please select (Yes/ No) _____

17.

Banking/Credit Facilities (Existing) (INR in lakhs)

Type of

Limit (in

Outstanding

Name of

Securities

Rate of

Repayment

Facilities

lakh)

as on

the Bank

Interest

Terms

and branch

Current

Account

Cash Credit

Term Loan

LC/BG

2

Others

Total

If banking with our Bank,

customer ID be given here

It is certified that our unit has

not availed any loan from any

other

Bank

/

Financial

Institution in the past and I am

not indebted to any other Bank

/  Financial

Institution  other

than those mentioned in column

no. 17 above.

18.

Credit Facilities (Proposed)

Type of Facilities

Amount (in lakh)

Purpose

for  which

Security Offered

Required

Primary

Whether   Collateral

Security(Details

Security Offered (If

with  approx.  value

,  yes,

then

provide

to be mentioned)

details

on

column

20)  (Yes/ No)

Cash Credit

Term Loan

LC/BG

Others

Total

Basis of Cash Credit Applied

Cash Credit

Projected

Sales

Working

Inventory

Debtors

Creditors

Other

Promoters

cycle in

Current

Contribution

months

Assets

19.

In case of term loan requirements, the details of machinery may be given as under:

Type

of

Purpose  for

Whether

Name

of

Total   Cost

Contribution

Loan

Machine/

which

Imported or

Supplier

of

Machine

being

made

Required

Equipment

Required

Indigenous

( in case of

by

the

imported

promoters

machine,

the

breakup

of

basic

costs,

freight,

insurance

and customs

duty may be

given)

20.

Details of Collateral Securities Offered, if any, including third party guarantee

(As per RBI guidelines banks are not to take collateral security for loans upto INR 10 Lakhs to

MSME Units)

a) Third Party Guarantee

Sl. No.

Name of

Residential

Telephone

Mobile No

Net worth

PAN No

Guarantor

Address

No.

(INR  in

(Residence)

lakh)

(i)

(ii)

(iii)

(iv)

(v)

a)  Other Collateral Security

Sl. No.

Name of owner of

Collateral Security

Collateral

Nature

Details

Value (Rs. in lakh)

(i)

(ii)

(iii)

4

(iv)

(v)

21.

Past Performance / Future Estimates

Past Performance / Future Estimates (Actual performance for two previous years, estimates for

current year and projections for next year to be provided for working capital facilities. However for

term loan facilities projections to be provided till the proposed year of repayment of loan)

Rs. in lakh

Past Year 1

Past Year 2

Present Year

Next Year

(Actual)

(Actual)

(Estimate)

(Projection)

Net Sales

Net Profit

Capital (Net

Worth in case of

Companies)

22.

Status Regarding Statutory Obligations:

Statutory Obligation: Remarks( Any details in Connection with the relevant obligation to be given)

Sl. No.

Whether Complied with (select Yes /No). If not applicable then select N. A.

(i)

Registration under Shops and Establishment ACT

Yes/ No/ NA

(ii)

Registration under MSME (Provisional /Final)

Yes/ No/ NA

(iii)

Drug License

Yes/ No/ NA

(iv)

Latest Sales Tax Return Filed

Yes/ No/ NA

(v)

Latest Income Tax Returns Filed

Yes/ No/ NA

(vi)

Any other Statutory dues remaining outstanding

Yes/ No/ NA

22

a.)  ID  Proof  (subject  to  the

satisfaction of bank)

Particulars of ID Proof

No. ______________

b.) Address Proof

Particulars of  Address Proof

No. ______________