Application ID: (For office use)

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS

EMPLOYMENT GENERATION PROGRAMME (PMEGP)
12 Name of the project / business activity proposed :

13 Amount of loan required (in Rs.)

Capital Expenditure Loan
Working
Building Type Workshed Machinery/ Pre
Capital /
Building Equipment/ Operative
Cash Credit Total
etc. Furniture Cost
Limit
Rented 0 300000 0 0 300000
Details of earlier or current Loan/Grant and subsidy availed from
14 Central/State Govt. Scheme/ or any other Similar Scheme.
Activity of the Project with Address Amount Year of Sanction

I certify that all information furnished by me is true; and that I and any of my dependent have not
borrowed any money under subsidy linked scheme from any Central / State Government or bank for
establishing any such project

Place:
Date: Signature of the Applicant

For Official Use only: (Rejected / to be placed before District Task force Committee)
Reason (if Rejected):

Place: Signature, Name & Designation of Officer

Date:
 NOTE

• Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North

East Reason/Hill Boarder Area and 10% for General
• Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for
service unit.
• Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own
Contribution over and above the prescribed limit.
• VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector
above Rs.5 lakhs
• Application should be submitted complete in all respect along with attested copies of the
following documents:
1. Certificate of qualification-academic and technical (if project cost above 5 lakhs under
service industry or above 10 lakhs under Manufacturing industry)
2. Relevant Certificate for SC/ST/OBC/Minority/Ex-Servicemen/PHC
3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks)
then submit photocopy of the certificate
 DATA INPUT SHEET

Preference for sponsoring agency of the project : (mark √ )

Unit Location (As per revenue record) : (mark √ )
KVIC KVIB DIC √ COIR Board
1.1 Name of the Applicant/Institution
SUNITA DEVI
1.2
HOUSE NO-83 NEW COLONY KHARIKABAD KENDUADIH DHANBAD-828116
2 Gender Male Female √ Transgender
3 Address of the Proposed location of Unit: Rural Urban √

5 Whether the applicant belongs to (mark √) ###

Ex- Service Aspirational
SC ST OBC PHC Minority Hill Border Area General
man Districts
√

Whether the project Manufacturing

6
(mark √) Unit √ Service Unit
8 Name of the project / business activity proposed :
SHOES AND CHAPPAL MAKING

Legal Status:

Land ###

BUILDING DETAILS
Particulars Area Rate/Sq.ft Amount in Rs.
SHOP 500 0.00 0.00
0.00
0.00
0.00
0.00
0.00
0.00

MACHINERY DETAILS
Particulars Qty. Rate Amount in Rs.
Shoe making Machine set 1 175000.00 175000.00
ShoeFarma 100 200.00 20000.00 Male
Cutting Machine 1 60000.00 60000.00
Tools Set 1 45000.00 45000.00 Trans
0.00 ###
0.00 KVIC
0.00 KVIB
0.00 DIC
0.00
0.00
0.00 Rural
0.00
0.00
Total 300000.00 No

d. Preliminary & Pre-operative Cost : SC

e. Furniture & Fixtures :

f. Contingency/Others/Miscellaneous

Working Capital : 0.00

Manu
 Means of Financing Unde

Own Contribution : 5%
Bank Finance : 95%
Margin Money (Govt. Subsidy) : 25%

DETAILS OF SALES Own

Rate/ Qantity Amount in Rs.
Particulars of Products
Unit
Shoes 250.00 2500 625000.00
Chappal 125.00 4000 500000.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 1125000.00

RAW MATERIALS
Particulars Unit Rate/Unit Reqd. Unit Amount In Rs.
Lather 25.00 5000 125000.00
Raxine 10.00 15000 150000.00
Others Matterials 43.00 1000 43000.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 318000.00

WAGES
No. of Wages Per Month Amount in Rs.
Particulars
Worker Total Month 12
Labor 5 6000.00 360000.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 5 360000.00

SALARY DETAILS
No. of Wages Per Month Amount in Rs.
Particulars
Staff Total Month 12
0.00
0.00
0.00
0.00
0.00
Total 0 0.00

WORKING CAPITAL ESTIMATE

Element of Working Capital No. of Days

Stock in process 28

Finished goods 30

Receivable by 26

POWER ESTIMATE
Power Requirement 1 kv

Repair and Maintanance Rs. 1000.00

Power and Fuel Rs. 1200.00

Other Overhead Expenses Rs. 500.00

Telephone Expenses Rs. 600.00

Stationery & Postage Rs. 200.00

Advertisement & Publicity Rs. 1000.00

Building Rent Rs. 4000.00

Other Miscelleneous Expenditure Rs. 1000.00

Rate of Interest 10.50%

Depreciation
On Building 10.00%
On Machinery 15.00%

INTRODUCTION
The shoe making is best business in the present maket.its demend is growing in day by day in Dhanbad city.
The shoe making is best business in the present maket.its demend is growing in day by day in Dhanbad city.

ABOUT THE BENEFICIARY

The proposed manufacturer is Schiduled Caste Woman and hard working lady.
 PROJECT AT A GLANCE - TOP SHEET
1 Name of the Beneficiary SUNITA DEVI

2 Constitution (legal Status) Individual

3 Father's/Spouce's Name HOUSE NO-83 NEW COLONY KHARIKABAD KENDUADIH DHANBAD-82811

4 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: 0
E-Mail : 0
Mobile 0
5 Product and By Product

6 Cost of Project : Rs. 5,00,079

Name of the project / business
SHOES AND CHAPPAL MAKING
activity proposed :
7 Means of Finance
Term Loan Rs. 4,75,075.00
KVIC Margin Money Rs. 1,25,020.00
Own Capital Rs. 25004.00

8 Debt Service :
Coverage Ratio

9 Pay Back Period : 5 Years

10 Project : 0 Months
Implementation
Period

11 Break Even Point :

12 Employment : 5

13 Power Requirement : 1 kv

14 Major Raw materials : Lather,Raxine,Others Matterials

15 Estimated Annual : Rs. 1125000.00

Sales Turnover

PMEGP Project Report Page 9

 DETAILED PROJECT REPORT
1 INTRODUCTION :

The shoe making is best business in the present maket.its demend is growing in day by day in Dhanbad city.

2 ABOUT THE BENEFICIARY :

The proposed manufacturer is Schiduled Caste Woman and hard working lady.

3 COST OF PROJECT
A. Fixed Capital Investment
a. Land : 0 Own

b. Workshed Area Sq.ft Rate in Rs. Amt. In Rs.

SHOP 500 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00
#REF!
C. Machinery Qty. Rate Amount in Rs.
Shoe making Machine set 1 175000.00 175000.00
ShoeFarma 100 200.00 20000.00
Cutting Machine 1 60000.00 60000.00
Tools Set 1 45000.00 45000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 300000.00

PMEGP Project Report Page 10

 d. Preliminary & Pre-operative Cost : Rs. 0.00

e. Furniture & Fixtures : Rs. 0.00

f. Contingency/Others/Miscellaneous Rs. 0.00

Total Capital Expenditure : Rs. 300000.00

Working Capital : Rs. 200079.00

Total Cost Project : Rs. 500079.00

3.1 Means of Financing :

Own Contribution 5% Rs. 25004.00

Bank Finance : 95%

Term Loan Rs. 285000.00
Working Capital Rs. 190075.00

Total Rs. 475075.00

Margin Money (Govt. Subsidy) From KVIC 25% Rs. 125020.00

Margin Money Subsidy received From KVIC will be kept in term deposit as per norms of
PMEGP in the name of Beneficiary for three years in the financing branch.

3.2 STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :
TERM LOAN

Interest @
Year Opening Balance Installment Closing Balance
10.50%
1st 285000 0 285000 29925
2nd 285000 57000 228000 29925
3rd 228000 57000 171000 23940
4th 171000 57000 114000 17955
5th 114000 57000 57000 11970
6th 57000 57000 0 5985
7th 0 0 0 0
8th 0 0 0 0

WORKING CAPITAL

Interest @
Year Opening Balance Installment Closing Balance
10.50%
1st 190075 0 190075 19958
2nd 190075 38015 152060 19958
3rd 152060 38015 114045 15966
4th 114045 38015 76030 11975
5th 76030 38015 38015 7983
6th 38015 38015 0 3992
7th 0 0 0 0
8th 0 0 0 0

PMEGP Project Report Page 11

3.3 STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:
WORKSHED @ 10.00%
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Opening Balance 0 0 0 0 0
Depreciation 0 0 0 0 0
Closing Balance 0 0 0 0 0
MACHINERY @ 15.00%
Opening Balance 300000 255000 216750 184238 156602
Depreciation 45000 38250 32513 27636 23490
Closing Balance 255000 216750 184238 156602 133112
TOTAL DEPRECIATION
Workshed 0 0 0 0 0
Machinery 45000 38250 32513 27636 23490
Total 45000 38250 32513 27636 23490

4 Schedule of Sales Realization :

4.1 Details of Sales
Rate/ No. of Amount in Rs.
Particulars of Product Pair/Unit Pair/Unit
0
Shoes 250.00 2500 625000.00
Chappal 125.00 4000 500000.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
Total 1125000.00

4.2 Capacity Utilization of Sales

Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year

Capacity Utilization 70% 80% 90% 90% 90%

Sales / Receipts 787500 900000 1012500 1012500 1012500

5 Rawmaterials :
Particulars Unit Rate/unit Reqd.Unit Amount in Rs.
Lather 0 25.00 5000 125000.00
Raxine 0 10.00 15000 150000.00
Others Matterials 0 43.00 1000 43000.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
Total 318000.00
5.1 Wages :
No. of Wages Amount in Rs.
Particulars Worker Per Month (Per Annum)
Labor 5 6000.00 360000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 5 360000.00

PMEGP Project Report Page 12

5.2 Repairs and Maintenance : Rs. 1000.00

PMEGP Project Report Page 13

5.3 Power and Fuel : Rs. 1200.00

5.4 Other Overhead Expenses : Rs. 500.00

6 Administrative Expenses :
6.1 Salary
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
Total 0 0.00

6.2 Telephone Expenses 600.00

6.4 Stationery & Postage 200.00

6.5 Advertisement & Publicity 1000.00

6.6 Workshed Rent 48000.00

6.7 Other Miscellaneous Expenses 1000.00

Total 50800.00
7 Capacity Utilization of Manufacturing & Administrative Expenses :
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Capacity Utilization 70% 80% 90% 90% 90%
Manufacturing Expenses
Raw materials 222600 254400 286200 286200 286200
Wages 252000 288000 324000 324000 324000
Repairs & Maintenance 700 800 900 900 900
Power & Fuel 840 960 1080 1080 1080
Other Overhead Expenses 350 400 450 450 450
Administrative Expenses
Salary 0 0 0 0 0
Postage Telephone Expenses 420 480 540 540 540
Stationery & Postage 140 160 180 180 180
Advertisement & Publicity 700 800 900 900 900
Workshed Rent 48000 48000 48000 48000 48000
Other Miscellaneous Expenses 700 800 900 900 900
Total: 526450 594800 663150 663150 663150
8 Assessment of Working Capital :
Particulars Amount in Rs.
Sale 1125000.00

Manufacturing Expenses
Raw Material 318000.00
Wages 360000.00
Repair & Maintenance 1000.00
Power & Fuel 1200.00
Other Overhead Expenses 500.00

Production Cost 680700.00

Administrative Cost 50800.00
Manufacturing Cost 731500.00

PMEGP Project Report Page 14

 Working Capital Estimate :
Element of Working Capital No of Days Basis Amount in Rs.
0 0 Material Cost 0.00

Stock in process 28 Production Cost 63532.00

Finished goods 30 Manufacturing Cost 73150.00

Receivable by 26 Manufacturing Cost 63397.00

Total Working Capital Requirement Per Cycle 200079.00

9 Financial Analysis
9.1 Projected Profit & Loss Account :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Sales / Receipts 787500 900000 1012500 1012500
787500 900000 1012500 1012500
Manufacturing Expenses
Raw materials 222600 254400 286200 286200
Wages 252000 288000 324000 324000
Repairs & Maintenance 700 800 900 900
Power & Fuel 840 960 1080 1080
Other Overhead Expenses 350 400 450 450
Depreciation 45000 38250 32513 27636
Production Cost 521490 582810 645143 640266
Administrative Expenses
Salary 0 0 0 0
Postage Telephone Expenses 420 480 540 540
Stationery & Postage 140 160 180 180
Advertisement & Publicity 700 800 900 900
Workshed Rent 48000 48000 48000 48000
Other Miscellaneous Expenses 700 800 900 900
Administrative Cost 49960 50240 50520 50520
Interest on Bank credit @ 10.5%
Term Loan 29925 29925 23940 17955
Working Capital Loan 19958 19958 15966 11975
Cost of Sale 621333 682933 735569 720715
Net Profit Before Tax 166167 217067 276931 291785
Less Tax 0.00 0.00 0.00 0.00
Net Profit 166167 217067 276931 291785

9.2 CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit 166167 217067 276931 291785
Add :
Depreciation 45000 38250 32513 27636
TOTAL - A 211167 255317 309444 319420
Payments :
On Term Loan :
Interest 29925 29925 23940 17955
Installment 0 57000 57000 57000
On Working Capital
Interest 19958 19958 15966 11975
TOTAL - B 49883 106883 96906 86930
D.S.C.R = A/B
4.23 2.39 3.19 3.67
Average D.S.C.R

PMEGP Project Report Page 15

9.3 PROJECTED BALANCE SHEET :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
LIABILITIES :
Beneficiary's Capital 25004 25004 25004 25004
Profit 166167 217067 276931 291785
Term Loan 285000 285000 228000 171000
Working Capital Loan 190075 190075 152060 114045
Current Liabilities 0 0 0 0
Sundry Creditors 0 0 0 0
666246 717146 681995 601834
ASSETS :
Gross Fixed Assets : 300000 255000 216750 184238
Less : Depreciation 45000 38250 32513 27636
Net Fixed Assets 255000 216750 184238 156602
Preliminary & Pre-Op. Expenses 0 0 0 0
Current Assets 190075 190075 152060 114045
Cash in Bank/Hand 221171 310321 345698 331187
Total 666246 717146 681995 601834

9.4 CASH FLOW STATEMENT :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit 166167 217067 276931 291785
Add : Depreciation 45000 38250 32513 27636
Term Loan 285000 285000 228000 171000
Working Capital Loan 190075 190075 152060 114045
Beneficiary's Capital 25004 0 0 0
Total 711246 730392 689504 604465

Total Fixed Capital Invested 300000

Repayment of Term Loan 0 57000 57000 57000

Repayment of WC Loan 0 38015 38015 38015
Current Assets 190075 190075 152060 114045
Total 190075 285090 247075 209060

Opening Balance 0 521171 966473 1408902

Surplus 521171 445302 442429 395405
Closing Balance 521171 966473 1408902 1804307

9.5 BREAK EVEN POINT AND RATIO ANALYSIS :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Fixed Cost 124885 118415 106973 96111
Variable Cost 541448 602768 661109 652240
Total Cost 666333 721183 768081 748351

Sales 787500 900000 1012500 1012500

Contribution (Sales-VC) 246052 297232 351391 360260

B.E.P in % 50.76% 39.84% 30.44% 26.68%

Break Even Sales in Rs. 399700 358553 308231 270116

Break Even Units 1599 1434 1233 1080

Current Ratio 3.81 1.31 1.13 0.91

PMEGP Project Report Page 16

 Net Profit Ratio 21.10% 24.12% 27.35% 28.82%

PMEGP Project Report Page 17

 This Project Report has been prepared based on the data furnished by the beneficiary whose details are
given in the application.
Place :
Date:
Prepared by :
Full Name : SUNITA DEVI

Signature of the Beneficiary

PMEGP Project Report Page 18

PMEGP Project Report Page 19
LED PROJECT REPORT

.its demend is growing in day by day in Dhanbad city.

and hard working lady.

PMEGP Project Report Page 20

 1.00

PMEGP Project Report Page 21

PMEGP Project Report Page 22
PMEGP Project Report Page 23
 PROJECT REPORT FOR

Affix latest
attested
Photograph

1 Name of the Beneficiary SUNITA DEVI

1
2 Constitution (legal Status) Individual

3 Father's/Spouce's Name #REF!

5 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: #REF!
Phone #REF!
E-Mail #REF!

6 Background of the Proprietor/Partners/Directors : Furnished detailed information in the DPR

7 Name of Business House/Group if any :

8 Details Other Companies/Units in the group :

Other Companies / Units in the Group (Rs. in Lakhs)
Name & Address Business Equity Reserves Loans Turnover *P.B.T **P.A.T
of Company / Unit

* Profit Before Tax ** Profit After Tax

`

8.1 How the activity was financed so far : ( To be filled up in case of existining unit Only )
*Source of Funds Security Rate of Repayment per Present O/s Amount of Default
Interest Month ( Rs. in '000 ) (if any)

8.2 If the Unit is an ancillary one, undertaking to

which it is catering and its address :
8.3 Employment : Present Proposed
Labor 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Total 5

9 Project Details for Proposed New Unit : Copy of detailed project report is enclosed.
a Expansion / Mordenisation :

b Setting up of New unit :

c Activity for proposed new unit :

d Product / Item proposed to undertake :

9.1 Capacity (Furnish the details of Installed capacity & production : (No. in Units/ Qty. in Kg./Volume in liter per annum)
Capacity is arrived at on the basis of Days working on shift basis
Product & Present Installed Maximum Prod. Proposed Installed Maximum Prod.
By-product if any Capacity Achieved Capacity of 1st Year envisaged
70.00% 521490

9.3 State the manufacturing process in brief :

9.4 Has the proposed process ever been tried in the
country or newly adopted? :

9.5 Technical Arrangements :

9.6 Describe arrangement for Key Official

for managing the proposed unit :
Technical Manpower

Administrative Manpower

Accounting personnel

9.7 Particulars of Land Existing Proposed

Location of the Land :
Area of Land
Status of the Land
Nature of Land
Availability of Water :

9.8 Particulars of Building Existing Proposed

(Enclose the plan & Estimation for the proposed Building) Area Value in Rs. Status Area Value Status
Factory Building :

Ancillary Building

Storage

Total 0.00 0.00

9.9 Plant and Machinery Existing (Value in Rs.) Proposed (Value in Rs.)
Indigenous 300000.00

Imported

(Enclose the plan layout of the existing plant and machinery )

9.10 Rawmaterials / Components
Req. of Raw material/Components/Chemicals Qty. in Nos./Kgs./Ton Rate/Nos./Kgs/Tons Value in Rs.

Total 0.00

9.11 Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)
Particulars of Utilities Contracted Load Connected Load Further requirement
in HP/KW/W in HP/KW/W in HP/KW/W
Power

Water

Fuel

Others (Specify)
9.12 Environment Aspect of the Project :

9.13 Requirement of Manpower for the Project :

Particulars of Manpower Total Requirement Salary/Wages per month Cost per Annum
Labor 5 6000.00 360000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 5 360000.00

9.14 Schedule of Implementation : BAR CHART

Activities Date of Commencement Expected Date of Completion
a. Acquisition of Land
b. Development of Land
c. Civil Works for Factory / Building
Machinery / Foundation etc..
d. Plant & Machinery
Imported
Indigenous
e. Arrangement for power
f. Arrangement for water
g. Errection of equipment
h. Commissioning
I. Procurement of Raw materials/Chemicals
j. Trail Runs
k. Commercial Production
10 Cost of Project :
(Rs. in '000)
Sr.No. Particulars Already Incurred To be Incurred Total Cost
A Land including Development 0.00 0.00

B Building & Other Civil Works 0.00 0.00

C Plant and Machinery

1. Indigenous 300000.00 300000.00
2. Imported 0.00

D Furniture & Fixture 0.00 0.00

E Testing equipment 0.00

F Miscellaneous Fixed Assets 0.00

G Errection & Installation Charges 0.00

H Contingency 0.00 0.00

I Preliminary & Pre-Op. Cost 0.00 0.00

J Provision for
1. Buildings 0.00
2. Plant & Machinery 0.00
3. Other Fixed Assets 0.00

K Working Capital for one 200079.00 200079.00

Operating Cycle

L Total 0.00 500079.00 500079.00

 11 Means of Financing :
(Rs. in '000)
Sr.No. Particulars Amount already Amount Proposed Total
Raised to be Raised
A Equity / Promoters Contribution 25004.00 25004.00

B Reserves 0.00

C Term Loans 475075.00 475075.00

D Unsecured Loans and Deposits 0.00

(Indicate sources, roi, repayment etc)

E Deferred Payment 0.00

Arrangements including Suppliers credit

F Subsidy
Central Government 125020.00 125020.00
State Government 0.00

G Seed Capital 0.00

H Internal Cash Accruals 0.00

I Other Sources (Specify) 0.00

J Total 0.00 500079.00 500079.00

11.1 In case internal accruals are taken as

source of finance explain the basis of
estimation of internal accruals :

11.2 Indicate source from which expenditure

already incurred has been financed :

11.3 % of Promoters contribution of the :

total cost of project
 12 Marketing & Selling Arrangements of the Product :

13 Projected Profitability : Projected Profitability Statement given in the

Detailed Project Report.

14 Projected Cash flow Statement : Projected Cash flow Statement given in the
Detailed Project Report.

% of Cash Sales in Total Sales :

Period in which payment is received Days

in respect of Credit Sales

Average Credit Available on Purchase : Days

15 Working Capital Required for the : Rs. 200079.00

anticipated turnover

16 Repayment Programme : Detailed Repayment programme for Term loan and

Working capital loan have been given in the DPR.

17 Details of Securities to be Offered :

17.1 Primary ( Furnish details for term loan and : :

working capital loan separately )
17.2 Collateral, if any (Details) :

17.3 Details of Guarantor(s) :

1. Name
2. Residential Address :

3. Occupation :
4. Details of movable & immovable
properties owned by him /her/other
family members

5 Details of any other similar guarantees:

if any, given to other institutions

18 Government Consents :
(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)

19 DECLARATION

I / We hereby declare that the information given herein before and the statements and other
papers enclosed are, to the best of our knowledge and belief, true and correct in all particulars

Date : 0 Signature of the Borrower

Place : 0 Name & Designation (In case of Regd. Inst.)
 Project Report on

Prepared By:
#REF!
District Industries Center
#REF!
#REF!
#REF! State: #REF!
e-Mail:
Ph. No.: Fax: