MSMEs�Loan Application

To be submitted along with documents as per the checklist

(For office Use)
Note: * fields are mandatory

Nearest City *

Nearest Branch *

NAME OF THE ENTERPRISE / BORROWER: *

REGD. OFFICE ADDRESS: *

ADDRESS OF FACTORY / SHOP

CONSTITUTION:

TELEPHONE NOs. (Office):

code :

Number :

MOBILE NO.:

EMAIL ADDRESS:

PAN CARD NO.:

DATE OF ESTABLISHMENT: *

10.

NAME OF PROPRIETOR / PARTNERS / DIRECTORS OF COMPANY AND THEIR ADDRESSES:

NAME	Date of Birth (DD/MM/YYYY)	ACADEMIC QUALIFICATIONS	RESIDENTIAL ADDRESS	TEL NO. (Residence)	EXPERIENCE IN THE LINE OF ACTIVITY

11.

Activity:

Existing:

Proposed (#)

# If a different activity other than the existing activity is proposed.

12.

Relationship of Proprietor/ Partner/ Director with the officials of the Bank / Director of the Bank , if any

13.

(a) CREDIT FACILITIES (EXISTING):

Type of facilities	Limit (In lacs)	Outstanding amount (In lacs)	Presently banking with	Security Offered	Rate of Interest	Repayment terms
Cash Credit
Term Loan
LC/ BG
Other
If Banking with this Bank, customer No. be given here.
13(b) 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 13(a) above.

14.

CREDIT FACILITIES (PROPOSED):

Type of facilities	Amount (In lacs)	Purpose for which required	Security offered
Type of facilities	Amount (In lacs)	Purpose for which required	PRIMARY SECURITY (Details with approx. value to be mentioned)	Whether Collateral Security offered (Please mention yes or no) (If yes, then provide details in para 15)
Cash Credit
Term Loan
LC/ BG
Others

15.

Details of Collateral Security offered, if any, including 3rd party guarantee*
(*As per RBI guidelines banks are not to take collateral security for loans upto Rs. 10 lakhs to MSME Units)

Description	Value (Rs. in lacs)

16.

Status regarding Statutory Obligations:

	Statutory Obligations	Whether Complied with (Select Yes/ No). If Not applicable then select N.A	Remarks (Any details in connection with the relevant obligation to be given)
1.	Registration under Shops and Establishment Act
2.	Registration under MSME (Provisional/Final)
3.	Drug License
4.	Latest Sales tax returns filed
5.	Latest Income tax returns filed
6.	Any other statutory dues remaining outstanding

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I / We hereby 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 an agency you may deem fit and you, your representatives, representatives of the 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.
CHECK-LIST OF DATA TO BE KEPT READY BY THE CUSTOMER

(The checklist is only indicative and not exhaustive and depending upon the local requirements at different places addition could be made as per necessity)