Relationships beyond Banking

Proposal No: GSP/SME/2022-23/50 Date: 19.08.2022

Application for MSME Loan

1. Name of the Enterprise MANOJ MISHRA

2. Regd. Office Address At/Po-Ghasipura,Dist-Keonjhar-758015
3. Address of Factory/Shop At/Po-Ghasipura,Dist-Keonjhar-758015
4. Premises (Owned/Rented/Leased) Owned
5. Telephone No 6370336218
6. E Mail Address
7. Mobile No 6370336218
8. PAN Card No ATJPM2790D
9. Constitution Individual
1 UdyogAdhaar No/Registration No No
0.
1 Date of 2007
1. Establishment/Incorporation
1 State Odisha
2.
1 City/District where Loan is Ghasipura/Keonjhar
3. required
1 Branch where loan is required (If BOI,Ghasipura.
4. any)
1 Name of Proprietor/Partners/Directors of Company and their addresses:
5.
Sr No 1:Proprietor/Partner/Director

Name Manoj Mishra

Date of Birth 23.07.1974
Father/Spouse Gopinath Mishra
Academic Qualification Graduate
Category Other
 SC/ST/OBC/Minority/Women
Mobile No 6370336218
PAN No ATJPM2790D
Residential Address At/Po-Ghasipura ,Dist-Keonjhar-758015
Aadhar No/DIN No 6441-7903-7951
Telephone Address (Residence)
Experience in the activity 11 years.

1 a) Activity Existing Transport Operator of Bus

6. b)Since
From Kupari to Champua
c)Proposed Activity (If activity other than
existing)
1 a) Whether the MSME unit is ZED rated NO
7. (Yes/No)
b)If Yes Gradation Obtained by MSME unit
(Bronze/Silver/Gold/Diamond/Platinum)
1 Name of Associates Concern & Nature of Association: N.A.
8.
Name Address Presently Nature of Extent of Interest
Banking with Associatio as a Prop/Partner/
n Director/just
investor in
associate concern
-- -- -- -- --

1 Relationship of Proprietors/Partners/Directors with the Officials

9. of the Bank/Director of Bank NO
2 Existing Banking/Credit Facilities: (In Lakhs)
0. Bank Of Indindia,Ghasipura Branch, Account No.540210100007643
No Credit facilities from other Bank/FI .

Facility Limit O/S as on Existing Securitie ROI Repayme

19.08.22 Banker s nt
Terms

Current - - -- -- -- --
Account
Cash Credit 20.00 10.80 Boi,Ghasipura HypoOf 9.35 On demand.

Stock.

GECL 2.00 1.26 Boi,Ghasipura Do 7.50

Loan-1
2.40 2.40 Boi,Ghasipura do 7.50
GECL-2

LC/BG

Others

Total 24.40 14.46

 If Banking with our Bank, Customer ID :

 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 20
above.

2 Credit Facilities (Proposed) (In Lakhs)

1.
Facility Amount Purpose Securities Offered
Primary Security Whether Collateral
(Details with Security Offered
approx. value to (If yes,then
be mentioned) provide details on
column 23,b)
(Yes/No)
Cash
Credit
Term Loan 35.00 Purchase of Hypothecation of No. To be covered
Ashok Leyland vehicle. under CGTMSE.
Bus
LC/BG
Others

Total

2 In case of Term Loan Requirements, the details of machinery may be given as

2. below:

Type Purpose Whether Name Total Contributio

of for Imported of Supplier Cost of n being
Machine/ which or Machine made by
Equipment Required Indigenou ( in case the
s of promoters
imported
machine
, the
breakup
of basic
costs,
[Link] Passeng Indigenou Sree Ganesh freight,
22.22
er Bus er Bus s Automobiles,Balasore
Ashok
Leyland
LT1509.9T6
R - 1. ViswakarmaBodyBuilder,Akera,Jai 19.50
4900MM ,di pur.
esel 150HP.

[Link] Of
Ashok
Leyland
2 2. Details of Collateral Securities Offered, if any, including third party
3 guarantee

(As per RBI guidelines banks are not to take collateral security for loans
up to Rs 10 Lakhs to MSME Units) Third Party Guarantee:
Name of Father/ Residential Telephone Net Aadh PAN
Guarant Spouse Address No Wort ar No No
or (Residenc h
e) (Rs
Mobile in
No lakhs
)

NIL

Other Collateral Security: NA since covered under CGTMSE guarantee.

Sr No Name of Owner of Collateral Security

Collateral
Nature Details Value (Rs
in lakhs)

2 Past Performance / Future Estimates

4
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 Past Year Present Next Year Installe Utilized
Year (Provisiona Year (Projectio d Capacit
FY202 l) (Estimat n) Capacit y
1 e) y
Net Sales
Net Profit
 Capital
(Net
Worth in
case of
2 Status Regarding Statutory Obligations:
5. 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

YES
ACT
2. Registration under MSME (Provisional /Final) Yes
3. Drug License NA
4. Latest Sales Tax Return Filed NA
[Link] Income Tax Returns Filed Yes
[Link] other Statutory dues remaining NA
2 IDoutstanding
PROOF (Any of the following)
6. Passport/ Voter Identity Card/ PAN
Card/ Driving License/ Job Card/
Aadhaar Card/ Identity Card (subject to
the satisfaction of bank)
GSTIN regd certificate
PAN CARD
ATJPM2790D
ADDRESS PROOF (Any of the 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/
Aadhaar Card.
GST NO
No.
2 Declaration: I/We hereby certify/authorize that all information furnished by me/us is
7 true, correct and complete; 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 have not been
declared as defaulter/willful defaulter by any Bank/FS and no Legal action has been
taken/initiated against me/us by any Bank/FIsI/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 authorized by you, may at any
time, inspect/ verify my/our assessment of account etc. in our factory/business
premises as given above; you may take appropriate safeguards/action for recovery
of Bank’s dues including publication of defaulters name in website/submission to
RBI; further agree that my/our loan shall be governed by the rules of your Bank
which may be in force from time to time.

Signature of the Borrower…

To be signed at Designated Branch only

Branch Name:

CHECK LIST

[Link] of Identity : Voter’s ID Card / Passport / Driving License / PAN Card /

Signature identification from present bankers of proprietor, partner of director ( if a
company)(not mentioned at 26 A above)
2. Proof of residence: Recent telephone bills, electricity bill, property tax receipt
/Passport / voter’s ID Card of Proprietor, partner of Director (if a company)
3. Proof of business Address (The list differs from 26 B above)
4. Applicant should not be defaulter in any Bank/F.I.
5. Last three years balance sheets of the units along with income tax / sales tax
returns etc. (Applicable for all cases from Rs 2 lakh and above) However, for cases
below fund based limits of Rs 25 lakh if audited balance sheets are not available, then
un audited balance sheets are also acceptable as per extant instructions of the bank.
6. Memorandum and articles of association of the Company / Partnership Deed of
partners etc.
7. Assets and liabilities statement of promoters and guarantors along with latest
income tax returns.
8. Rent Agreement (if business premises on rent) and clearance from pollution
control board if applicable.
9. SSI / MSME registration if applicable.
10. 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 Rs 2 lakh and
above).
11. In case of takeover of advances, sanction letters of facilities being availed from
existing bankers/ Financial Institutions along with detailed terms and conditions.
12. Photocopies of lease deeds/ title deeds of all the properties being offered as
primary and collateral securities.
13. Position of accounts from the existing bankers and confirmation about the asset
being standard with them. (in case of takeover).
14. Copy of VAT return if applicable.
For Cases with Exposure above 25 Lakh
15. The audited balance sheets are necessary.
16. 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.
17. Last three years balance sheets of the Associate / Group Companies (if any).
18. 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.
[Link] 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, bank’s outstanding for working
capital limits, term loan limits, bills discounted.
[Link] 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 company’s 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).

Data /information mentioned a point no. 17, 18, 19 may be sought from unit requesting
limit of Rs. 50 lacs and above.
 Relationships beyond Banking

Proposal No: GSP/AFD/2022-23/ Date:

Application for MSME Loan

1. Name of the Enterprise M/S Krupasindhu Food Product &

Processing Centre
2. Regd. Office Address At-Jharkhundi,Po-Balarampur,Dist-Keonjhar-
 758020
3. Address of Factory/Shop At-Jharkhundi,Po-Balarampur,Dist-Keonjhar-
758020
4. Premises (Owned/Rented/Leased) Owned
5. Telephone No 6370252767
6. E Mail Address
7. Mobile No 6370252767
8. PAN Card No AAXFK3577H
9. Constitution Partnership Firm
1 UdyogAdhaar No/Registration No
0.
1 Date of 2021
1. Establishment/Incorporation
1 State Odisha
2.
1 City/District where Loan is Ghasipura/Keonjhar
3. required
1 Branch where loan is required (If BOI,Ghasipura.
4. any)
1 Name of Proprietor/Partners/Directors of Company and their addresses:
5.
Sr No 1:Proprietor/Partner/Director

Name AurobindaSahoo
Date of Birth 10.07.1984
Father/Spouse MadhabanandaSahoo
Academic Qualification B.E.
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 7978767265
PAN No CMIPS7808E
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 6351-3002-1860
Telephone Address (Residence)
Experience in the activity 12 years.

Sr No 2:Proprietor/Partner/Director

Name MadhabanandaSahoo
Date of Birth 02.08.1953
Father/Spouse SyamsundarSahoo.
Academic Qualification Graduate
Category OBC
 SC/ST/OBC/Minority/Women
Mobile No 6371252767
PAN No BDDPS4860H
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 7540-8433-9729
Telephone Address (Residence)
Experience in the activity 12 years.

Sr No 3:Proprietor/Partner/Director

Name RosaliSahoo
Date of Birth 18.05.1988
Father/Spouse AurobindaSahoo
Academic Qualification Graduate
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 8895270047
PAN No DPQPS0113N
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 874583408318
Telephone Address (Residence)
Experience in the activity Na

Sr No 4:Proprietor/Partner/Director

Name PritilataSahoo
Date of Birth 28.06.1996
Father/Spouse Ajit Kumar Sahoo
Academic Qualification Graduate
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 7978767265
PAN No NOIPS0274B
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 549884195761
Telephone Address (Residence)
Experience in the activity 0 year

Sr No 5:Proprietor/Partner/Director
 Name SabitaSahoo
Date of Birth 27.05.1963
Father/Spouse MadhabanandaSahoo
Academic Qualification Graduate
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 7978767265
PAN No AXXPS2225B
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 426409695097
Telephone Address (Residence)
Experience in the activity .
1 a) Activity Existing Custom Rice Milling
6. b)Since
Since Nov.2021.
c)Proposed Activity (If activity other than
existing)
1 a) Whether the MSME unit is ZED rated NO
7. (Yes/No)
b)If Yes Gradation Obtained by MSME unit
(Bronze/Silver/Gold/Diamond/Platinum)
1 Name of Associates Concern & Nature of Association: N.A.
8.
Name Address Presently Nature of Extent of Interest
Banking with Associatio as a Prop/Partner/
n Director/just
investor in
associate concern
-- -- -- -- --

1 Relationship of Proprietors/Partners/Directors with the Officials

9. of the Bank/Director of Bank NO
2 Existing Banking/Credit Facilities: (In Lakhs)
0. Bank Of Indindia,Ghasipura Branch, Account No.540230110000180
No Credit facilities from other Bank/FI .

Facility Limit O/S as Existing Securitie ROI Repayme

on Banker s nt
19.08.22 Terms

Current - - -- -- -- --
Account
Cash Credit 20.00 Boi,Ghasipura HypoOf 9.35 On demand.

Stock.

Term Loan 230.00 Boi,Ghasipura Do 7.50

Boi,Ghasipura do 7.50

LC/BG 300.00

Others

Total 550.00

 If Banking with our Bank, Customer ID :

 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 20
above.

2 Credit Facilities (Proposed) (In Lakhs)

1.
Facility Amount Purpose Securities Offered
Primary Whether Collateral
Security Security Offered
(Details with (If yes,then
approx. value to provide details on
be mentioned) column 23,b)
(Yes/No)
Cash 40.00 Rice milling Yes
(existing
Credit
20.00lakh
)
Term
Loan
LC/BG 150.00 Paddy Yes
(existing- procurement
Rs.300lak from
h) [Link]
r
 Others 190.00

Total

2 In case of Term Loan Requirements, the details of machinery may be given as

2. below:

Type Purpose Whether Name Total Cost of Contribution

of Machine/ for Imported of Supplier Machine ( in being made
Equipment which or case of by the
Required Indigenou imported promoters
s machine, the
breakup of
basic costs,
freight,
insurance
and customs
duty may be
given)
2 3. Details of Collateral Securities Offered, if any, including third party
3 guarantee

(As per RBI guidelines banks are not to take collateral security for loans
up to Rs 10 Lakhs to MSME Units) Third Party Guarantee:
Name of Father/ Residential Telephone Net Aadh PAN
Guarant Spouse Address No Wort ar No No
or (Residenc h
e) (Rs
Mobile in
No lakhs
)

Other Collateral Security:

Sr No Name of Owner of Collateral Security

Collateral
Nature Details Value (Rs
in lakhs)
1 MadhabanandaSahoo Factory Land Khata no.302/172
Plot no.1344/2525
304.38
1359\2527,1345/2526
total area Ac.1.59 dec

2 In the name of TDR 540245110003214, 104.05

Partners 540245100000313
4511-1455,4511-
1454,4511-
1453,4511-
3216,4511-
1376,4511-
3217,4511-
1377,4511-
1375,4411-
397,4411-
398,4411-399
2 Past Performance / Future Estimates
4
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 Past Year Present Next Year Installe Utilized
Year (Audited) Year (Projectio d Capacit
FY202 (Estimat n) Capacit y
1 e) y
Net Sales 75.00 360.00 402
Net Profit 17.70 20.75 27.74
Capital
(Net
Worth in
case of
2 Status Regarding Statutory Obligations:
5. 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.

5. Registration under Shops and Establishment

YES
ACT
6. Registration under MSME (Provisional /Final) Yes
7. Drug License NA
8. Latest Sales Tax Return Filed NA
[Link] Income Tax Returns Filed Yes
[Link] other Statutory dues remaining NA
2 IDoutstanding
PROOF (Any of the following)
6. Passport/ Voter Identity Card/ PAN
Card/ Driving License/ Job Card/
Aadhaar Card/ Identity Card (subject to
the satisfaction of bank)
GSTIN regd certificate
PAN CARD
AAXFK3277H
ADDRESS PROOF (Any of the 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/
Aadhaar Card.
GST NO
21AAXFK3577H1ZX
2 Declaration: I/We hereby certify/authorize that all information furnished by me/us is
7 true, correct and complete; 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 have not been
declared as defaulter/willful defaulter by any Bank/FS and no Legal action has been
taken/initiated against me/us by any Bank/FIsI/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 authorized by you, may at any
time, inspect/ verify my/our assessment of account etc. in our factory/business
premises as given above; you may take appropriate safeguards/action for recovery
of Bank’s dues including publication of defaulters name in website/submission to
RBI; further agree that my/our loan shall be governed by the rules of your Bank
which may be in force from time to time.

Signature of the Borrower…

To be signed at Designated Branch only

Branch Name:

CHECK LIST

[Link] of Identity : Voter’s ID Card / Passport / Driving License / PAN Card /

Signature identification from present bankers of proprietor, partner of director ( if a
company)(not mentioned at 26 A above)
2. Proof of residence: Recent telephone bills, electricity bill, property tax receipt
/Passport / voter’s ID Card of Proprietor, partner of Director (if a company)
3. Proof of business Address (The list differs from 26 B above)
4. Applicant should not be defaulter in any Bank/F.I.
5. Last three years balance sheets of the units along with income tax / sales tax
returns etc. (Applicable for all cases from Rs 2 lakh and above) However, for cases
below fund based limits of Rs 25 lakh if audited balance sheets are not available, then
un audited balance sheets are also acceptable as per extant instructions of the bank.
6. Memorandum and articles of association of the Company / Partnership Deed of
partners etc.
7. Assets and liabilities statement of promoters and guarantors along with latest
income tax returns.
8. Rent Agreement (if business premises on rent) and clearance from pollution
control board if applicable.
9. SSI / MSME registration if applicable.
10. 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 Rs 2 lakh and
above).
11. In case of takeover of advances, sanction letters of facilities being availed from
existing bankers/ Financial Institutions along with detailed terms and conditions.
12. Photocopies of lease deeds/ title deeds of all the properties being offered as
primary and collateral securities.
13. Position of accounts from the existing bankers and confirmation about the asset
being standard with them. (in case of takeover).
14. Copy of VAT return if applicable.
For Cases with Exposure above 25 Lakh
15. The audited balance sheets are necessary.
16. 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.
17. Last three years balance sheets of the Associate / Group Companies (if any).
18. 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.
[Link] 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, bank’s outstanding for working
capital limits, term loan limits, bills discounted.
[Link] 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 company’s 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).

Data /information mentioned a point no. 17, 18, 19 may be sought from unit requesting
limit of Rs. 50 lacs and above.
 Relationships beyond Banking

Proposal No: GSP/AFD/2022-23/74 Date: 11.11.2022

Application for MSME Loan

1. Name of the Enterprise M/S SHREE SHYAMSUNDAR RICE MILL

2. Regd. Office Address At-Jharkhundi,Po-Balarampur,Dist-Keonjhar-
758020
3. Address of Factory/Shop At-Jharkhundi,Po-Balarampur,Dist-Keonjhar-
758020
4. Premises (Owned/Rented/Leased) Owned
5. Telephone No 6370252767
6. E Mail Address
7. Mobile No 6370252767
8. PAN Card No ABJFS0120K
9. Constitution Partnership Firm
1 UdyogAdhaar No/Registration No
0.
1 Date of 03.04.2014
1. Establishment/Incorporation
1 State Odisha
2.
1 City/District where Loan is Ghasipura/Keonjhar
3. required
1 Branch where loan is required (If BOI,Ghasipura.
4. any)
1 Name of Proprietor/Partners/Directors of Company and their addresses:
5.
Sr No 1:Proprietor/Partner/Director

Name AurobindaSahoo (Partner)

Date of Birth 10.07.1984
Father/Spouse MadhabanandaSahoo
 Academic Qualification B.E.
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 7978767265
PAN No CMIPS7808E
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 6351-3002-1860
Telephone Address (Residence)
Experience in the activity 12 years.

Sr No 2:Proprietor/Partner/Director

Name MadhabanandaSahoo (Managing Partner)

Date of Birth 02.08.1953
Father/Spouse SyamsundarSahoo.
Academic Qualification Graduate
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 6371252767
PAN No BDDPS4860H
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 7540-8433-9729
Telephone Address (Residence)
Experience in the activity 12 years.

Sr No 3:Proprietor/Partner/Director

Name Ajit Kumar Sahoo

Date of Birth 10.08.1988
Father/Spouse Madhabananda Sahoo
Academic Qualification Graduate
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 8895270047
PAN No BIAPS6957D
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 768317164341
Telephone Address (Residence)
Experience in the activity Na
 Sr No 4:Proprietor/Partner/Director

Name SabitaSahoo
Date of Birth 27.05.1963
Father/Spouse MadhabanandaSahoo
Academic Qualification Graduate
Category OBC
SC/ST/OBC/Minority/Women
Mobile No 7978767265
PAN No AXXPS2225B
Residential Address Kainipura,Sailong ,Dist-Keonjhar-758015
Aadhar No/DIN No 426409695097
Telephone Address (Residence)
Experience in the activity .
1 a) Activity Existing Custom Rice Milling
6. b)Since
Since 2007
c)Proposed Activity (If activity other than
existing)
1 a) Whether the MSME unit is ZED rated NO
7. (Yes/No)
b)If Yes Gradation Obtained by MSME unit
(Bronze/Silver/Gold/Diamond/Platinum)
1 Name of Associates Concern & Nature of Association: N.A.
8.
Name Address Presently Nature of Extent of Interest
Banking with Associatio as a Prop/Partner/
n Director/just
investor in
associate concern
-- -- -- -- --

1 Relationship of Proprietors/Partners/Directors with the Officials

9. of the Bank/Director of Bank NO
2 Existing Banking/Credit Facilities: (In Lakhs)
0. Bank Of Indindia,Ghasipura Branch, Account No.540230110000088
No Credit facilities from other Bank/FI .

Facility Limit O/S as Existing Securitie ROI Repayme

on Banker s nt
Terms

Current - - -- -- -- --
Account
Cash Credit 60.00 Boi,Ghasipura HypoOf 9.35 On demand.

Stock.

Term Loan

LC/BG 100.00 do EQM of

factory land

&building

Others

Total 160.00

 If Banking with our Bank, Customer ID :

 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 20
above.

2 Credit Facilities (Proposed) (In Lakhs)

1.
Facility Amoun Purpose Securities Offered
t
Primary Whether
Security Collateral Security
(Details with Offered (If
approx. value yes,then provide
to be details on column
mentioned) 23,b)
(Yes/No)
Cash Credit Yes

Term Loan
LC/ 100.00 Paddy BG margin 15% Yes
BG(Casual) procurement in term of FD.
from
[Link]
 r
Others

Total

2 In case of Term Loan Requirements, the details of machinery may be given as

2. below:

Type Purpose Whether Name Total Cost of Contribution

of Machine/ for Imported of Supplier Machine ( in being made
Equipment which or case of by the
Required Indigenou imported promoters
s machine, the
breakup of
basic costs,
freight,
insurance
and customs
duty may be
given)

2 4. Details of Collateral Securities Offered, if any, including third party

3 guarantee

(As per RBI guidelines banks are not to take collateral security for loans
up to Rs 10 Lakhs to MSME Units) Third Party Guarantee:
Name of Father/ Residential Telephone Net Aadh PAN
Guarant Spouse Address No Wort ar No No
or (Residenc h
e) (Rs
Mobile in
No lakhs
)

Other Collateral Security:

Sr No Name of Owner of Collateral Security

Collateral
Nature Details Value (Rs
in lakhs)
 1 MadhabanandaSahoo Factory Land Khata no.302/172
Plot no.1344/2525
77.21
1359\2527,1345/2526
total area Ac.1.59 dec

2 For casual BG
Sabita Sahoo Residential Land & khata no-364/876
Building located at plot no-1930/6743
Kainipura,Sailong, and khata no.239/299
255.00(DV)
Ghasipura and plot no.2/1888 ,
14/2112,14/2113
Total area Ac.0.25 dec.
3 In the name of TDR 38.09 38.09
Partners
2 Past Performance / Future Estimates
4
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 Past Year Present Next Year Installe Utilized
Year (Audited) Year (Projectio d Capacit
FY202 (Estimat n) Capacit y
1 e) y
Net Sales
Net Profit
Capital
(Net
Worth in
case of
2 Status Regarding Statutory Obligations:
5. 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.

9. Registration under Shops and Establishment

YES
ACT
10. Registration under MSME (Provisional Yes
/Final)
11. Drug License NA
12. Latest Sales Tax Return Filed NA
[Link] Income Tax Returns Filed Yes
[Link] other Statutory dues remaining NA
2 IDoutstanding
PROOF (Any of the following)
6. Passport/ Voter Identity Card/ PAN
Card/ Driving License/ Job Card/
Aadhaar Card/ Identity Card (subject to
the satisfaction of bank)
GSTIN regd certificate
 PAN CARD
ABJFS0120K
ADDRESS PROOF (Any of the 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/
Aadhaar Card.
GST NO
21ABJFS0120K1ZL
2 Declaration: I/We hereby certify/authorize that all information furnished by me/us is
7 true, correct and complete; 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 have not been
declared as defaulter/willful defaulter by any Bank/FS and no Legal action has been
taken/initiated against me/us by any Bank/FIsI/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 authorized by you, may at any
time, inspect/ verify my/our assessment of account etc. in our factory/business
premises as given above; you may take appropriate safeguards/action for recovery
of Bank’s dues including publication of defaulters name in website/submission to
RBI; further agree that my/our loan shall be governed by the rules of your Bank
which may be in force from time to time.

Signature of the Borrower…

To be signed at Designated Branch only

Branch Name:

CHECK LIST

[Link] of Identity : Voter’s ID Card / Passport / Driving License / PAN Card /

Signature identification from present bankers of proprietor, partner of director ( if a
company)(not mentioned at 26 A above)
2. Proof of residence: Recent telephone bills, electricity bill, property tax receipt
/Passport / voter’s ID Card of Proprietor, partner of Director (if a company)
3. Proof of business Address (The list differs from 26 B above)
4. Applicant should not be defaulter in any Bank/F.I.
5. Last three years balance sheets of the units along with income tax / sales tax
returns etc. (Applicable for all cases from Rs 2 lakh and above) However, for cases
below fund based limits of Rs 25 lakh if audited balance sheets are not available, then
un audited balance sheets are also acceptable as per extant instructions of the bank.
6. Memorandum and articles of association of the Company / Partnership Deed of
partners etc.
7. Assets and liabilities statement of promoters and guarantors along with latest
income tax returns.
8. Rent Agreement (if business premises on rent) and clearance from pollution
control board if applicable.
9. SSI / MSME registration if applicable.
10. 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 Rs 2 lakh and
above).
11. In case of takeover of advances, sanction letters of facilities being availed from
existing bankers/ Financial Institutions along with detailed terms and conditions.
12. Photocopies of lease deeds/ title deeds of all the properties being offered as
primary and collateral securities.
13. Position of accounts from the existing bankers and confirmation about the asset
being standard with them. (in case of takeover).
14. Copy of VAT return if applicable.
For Cases with Exposure above 25 Lakh
15. The audited balance sheets are necessary.
16. 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.
17. Last three years balance sheets of the Associate / Group Companies (if any).
18. 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.
[Link] 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, bank’s outstanding for working
capital limits, term loan limits, bills discounted.
[Link] 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 company’s 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).

Data /information mentioned a point no. 17, 18, 19 may be sought from unit requesting
limit of Rs. 50 lacs and above.