ANNEXURE A
Application for MSME Loan upto .100 Lakhs
Date: _______
1. Name of the Enterprise* _______________
2. Regd. Office Address* __________________
3. Address of Factory/Shop* __________________
4. Whether Belongs to SC/ST/OBC/Minority Community: Yes / No
Photograph to
be pasted at the
time of signing
of the
application in the
designated
branch.
If Yes, then Please Select: SC/ ST/ OBC/ Minority Community
5. Telephone No.* __________
6. E mail Address*_______________
7. Mobile No.* __________
8. PAN Card No. _______________
9. Constitution (Please Select)* Individual/ Joint/ Prop. Concern/Partnership/ Pvt Ltd Co/
Limited Co/ Trust/ others
10. Date of Establishment* ___________
11. State *__________
12. City where loan is required* __________ District_____________
13. Branch where loan is required. (If any) ___________
14. Name of Proprietors/ Partners/ Directors of Company and Their Addresses: *
[Link]
Name
Date of
Birth
Father/
Spouse
Academic
Qualification
Mobile No
1.
2.
3.
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[Link] PAN No.
Residential Address
Telephone
No.
(Residence)
Experience in the
line of activity
(Years)
1.
2.
3.
15. Activity* Existing _______ since _________
Proposed# _________
#if a different activity other than existing activity is proposed.
16. Names of Associate Concerns and Nature of Association:
Name of
Associate
Concerns
Address of
Associate
Concerns
Presently
Banking With
Nature of
Association
Extent of
Interest as a
Prop./ Partner/
Director or Just
Investor in
Associate
Concern
Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of the
Bank: Please select (Yes/ No) _____
17. Banking/Credit Facilities (Existing) (. in lakh)
Type of
Facilities
Limit (in
lakh)
Outstanding Presently
as on
Banking
With
Securities
Rate of
Interest
Repayment
Terms
Current
Account
Cash
Credit
Term Loan
LC/BG
Others
Total
If banking with our Bank, customer ID be given here: __________
Sub-Committee on MSME to create a structured mechanism for the MSE sector
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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
Required
Security Offered
Primary
Whether Collateral
Security(Details with
Security Offered (If ,
approx. value to be
yes, then provide
mentioned)
details on column 20)
(Yes/ No)
Cash Credit**
Term Loan
LC/BG
Others
Total
*Mandatory Fields
**Basis of Cash Credit Limit applied
Cash
Credit
Sales
Working
Cycle in
months
Inventory
Projected
Debtors
Creditors
Other
current
assets
Promoters
Contribution
19. In case of term loan requirements, the details of machinery may be given as under:
Type of
Machine/
Purpose
for which
Equipment 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 Loan
being made Required
by the
promoters
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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 . 10
Lakhs to MSME Units)
a) Third Party Guarantee:
[Link] Name of
Guarantor
Residential Telephone
Mobile
Address
No.
No
(Residence)
Net worth
(. in lakh)
PAN
No
1.
2.
3.
b) Other Collateral Security:
[Link]
Name of owner of
Collateral
Collateral Security
Nature
Details
Value (Rs. in lakh)
1.
2.
3.
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)
Whether Complied with (select Yes /No). If not applicable then select N. A.
1. Registration under Shops and Establishment ACT
Yes/ No/ NA
2. Registration under MSME (Provisional /Final)
Yes/ No/ NA
3. Drug License
Yes/ No/ NA
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4. Latest Sales Tax Return Filed
[Link] Income Tax Returns Filed
[Link] other Statutory dues remaining outstanding
22. a.)
Yes/ No/ NA
Yes/ No/ NA
Yes/ No/ NA
ID Proof (Any of following):
Passport/ Voter Identity Card/ PAN Card/ Driving Licence/ Job Card/ Aadhaar Card/
Identity Card (subject to the satisfaction of bank)
ID Proof No. ______________
b.) Address Proof (Any of following:
Electricity Bill/ Telephone Bill/ Bank Account Statement of any other bank/ Letter
from reputed employer/ Letter from recognized public authority verifying the
address of the customer to the satisfaction of the bank/ Ration Card
Address Proof No:
Declaration:
I/We hereby certify that all information furnished by me/us is true; that I/We have no
borrowing arrangements for the unit except is in the application; that there is no over dues/
statutory dues against me/us/promoters except as indicated in the application; that I/We
shall furnish all other information that may be required connection with my/our application
that this may also be exchanged by you with an agency you may deem fit and you, your
representatives or Reserve Bank of India or any other agency as authorised by you, may at
any time, inspect/ verify my/our assessment of account etc. in our factory/business premises
as given above.
Signature:
To be signed at the designated branch only
CHECK LIST
1.
2.
3.
4.
5.
6.
Proof of Identity : Voters ID Card / Passport / Driving License / PAN Card / Signature
identification from present bankers of proprietor, partner of director ( if a company)
Proof of residence: Recent telephone bills, electricity bill, property tax receipt
/Passport / voters ID Card of Proprietor, partner of Director (if a company)
Proof of business Address
Applicant should not be defaulter in any Bank/F.I.
Last three years balance sheets of the units along with income tax / sales tax returns
etc. (Applicable for all cases from . 2 lakh and above) However, for cases below
fund based limits of . 25 lakh if audited balance sheets are not available, then un
audited balance sheets are also acceptable as per extant instructions of the bank.
Memorandum and articles of association of the Company / Partnership Deed of
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7.
8.
9.
10.
11.
12.
13.
partners etc.
Assets and liabilities statement of promoters and guarantors along with latest income
tax returns.
Rent Agreement (if business premises on rent) and clearance from pollution control
board if applicable.
SSI / MSME registration if applicable.
Projected balance sheets for the next two years in case of working capital limits and
for the period of the loan in case of term loan (For all cases of . 2 lakh and above).
In case of takeover of advances, sanction letters of facilities being availed from
existing bankers/ Financial Institutions along with detailed terms and conditions.
Photocopies of lease deeds/ title deeds of all the properties being offered as primary
and collateral securities.
Position of accounts from the existing bankers and confirmation about the asset
being standard with them. (in case of takeover).
For Cases With Exposure Above . 25 Lakhs
14.
15.
16.
17.
18.
19.
The audited balance sheets are necessary.
Profile of the unit (includes names of promoters, other directors in the company, the
activity being undertaken addresses of all offices and plants, shareholding pattern
etc.
Last three years balance sheets of the Associate / Group Companies (if any).
Project report (for the proposed project if term funding is required) containing details
of the machinery to be acquired, from whom to be acquired, price, names of
suppliers, financial details like capacity of machines, capacity of utilization assumed,
production, sales, projected profit and loss and balance sheets for the next 7 to 8
years till the proposed loan is to be paid, the details of labour, staff to be hired, basis
of assumption of such financial details etc.
Review of account containing month wise sales (quantity and value both), production
(quantity and value), imported raw material (quantity and value), indigenous raw
material (quantity and value), value of stocks in process, finished good (quantity and
value), debtors, creditors, banks outstanding for working capital limits, term loan
limits, bills discounted.
Manufacturing process if applicable, major profile of executives in the company, any
tie-ups, details about raw material used and their suppliers, details about the buyers,
details about major-competitors and the companys strength and weaknesses as
compared to their competitors etc.
.
(The check list is only indicative and not exhaustive and depending upon the local
requirements at different places addition could be made as per (necessity).
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