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APPLICATION FORM FOR MSME LOAN

(Please Read The Application Form Carefully Before Filling. Fields With * Are Mandatory.)		  
   
1. Application No. 2. Date (mm/dd/yyyy):
2.Name Of The Enterprise*
3. Regd. Office Address*
4. Address of Factory/Shop*
5. Whether Belongs to SC/ST/OBC/Minority Community If Yes, then Please Select
6.Telephone No.* 7.E mail Address*
8. Mobile No.* 9. PAN Card No.
10. Constitution* 11. Date Of Establishment*
12.Select State*
13.Select Branch where loan is required*
14. Name of Proprietors/ Partners/Directors of Company and Their Addresses: *
Name Age Academic Qualification Residential Address Telephone No. (Residence) Experience in the line or activity (Years)
15.Activity Existing*

 

Proposed#

#If a different activity other than existing activity is proposed.
16. Names of Associate Concerns and Nature of Association:
     
Name of Associate Concern Address of Associate Concern Presently Banking With Nature of Association Extent of Interest as a Prop./ Partner/ Director or Just Investor in Associate Concern
Relationship of Proprietors/Partners/Director with the officials of the Bank/Director of the Bank
 17(a).Credit Facilities(Existing)(Rs.In Lakhs)
    
Type of Facilities Limit(in lakh) Outstanding as on ... Presently Banking With Security Lodged Rate of Interest Repayment Terms
If Banking with this Bank,Customer NO. be given here.
17(b):It is certified that our unit has not availed any loan from any other Bnak/ Financial Institution in the past and I am not indebted to any other Bank/Financial Institution other than those mentioned in the 17(a)columns
18. Credit Facilities (Proposed)*
Type of Facilities Amount(in lakh) Purpose for which Required Security Offered
      Primary Security (Details with approx. value to be mentioned) Whether Collateral Security Offered (Please mention yes or no) (If yes, then provide details field NO. 20)

19.In case of term loan requirements, the details of machinery may be given as under:
Type of Machine Purpose for which Required Whether Imported or Indigenous Name of Supplier Total Cost of Machine ( in case of imported machine, the breakup of basic costs, freight, insurance and customs duty may be given) Contribution being made by the promotors Loan Required

20. Details of Collateral Security Offered, if any, including third party Guarantee #

(# As per RBI guidelines banks are not to take collateral security for loans upto Rs. 10 lakhs to MSE Units)

Type of Facilities Collateral Security Offered Details of Colletral security

 

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 lacs Past Year II (Actual) Past Year I(Actual) Present Year (Estimate) Next Year (Projection)
 
21. Status Regarding Statutory Obligations:

 

Statutory Obligation Whether Complied with (select Yes/No).If not applicable then select NA Remarks(Any details in Connection with the relevant obligaiton to be given)
Validation Code:*
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I/We certify that all information furnished by me/us is true; that I/We have no borrowing arrangements for the unit except as indicated in the application; that there is no overdues/statutory dues against me/us/promoters except as indicated in the application; that no legal action has been/is being taken against me/us/promoters; that I/We shall furnish all other information that may be required by you in connection with my/our application that this may also be exchanged by you with any agency you may deemed fit and you,your representatives, representatives of Reserve Bank of India or any other agency as authorised by you,may,at any time,inspect/verify my/our assets,books of account etc. in our factory/business premises as given above.
         
Application is subject to production of documentary proof of KYC requirements fixed by RBI & Other needful documents