Common Application Format for MSME Loans- IBA Approved
Application for MSME Loans
Date: 19.06.2026
1. Name of the Enterprise*: Mr. Davidkumar G
2. Regd. Office Address*: 80/1 Kangai Amman Kovil Street, Kilpattu, Pin- 606907
3. Address of Factory/Shop*: NA Photograph to be
4. Premises (Owned/Rented/Leased): Owned pasted at the time
of signing of the
5. Telephone No*: Nil
application in the
6. E-mail Address*:
designated Branch
7. Mobile No*: 9677465290
8. PAN Card No: BMAPD0813M
9. Constitution (Please select)*: Individual
10. Udyog Aadhaar No/ Registration No: UDYAM-TN-
10(a). GST No. (If applicable): Nil
11. Date of Establishment/ Incorporation*: 18.02.2026
12. State*: Tiruvannamalai
13. City where loan is required*: Vadamathimangalam District*: Tiruvannamalai
14. Branch where loan is required (if any): Vadamathimangalam
15. Name of Proprietors/Partners/Directors of Company and there address*:
Sl. No. Name Date of Father/ Spouse Academic Category (SC/ ST/ Mobile No.
Birth Qualification OBC/ Minority/
Woman)
1. Davidkumar 03.04.1993 Govindasamay B.E. General 9677465290
G
Sl. No. PAN No. Residential Address Aadhaar No./ Telephone No. Experience in
DIN No. (Residence) the line of
activity
1. BMAPD0813M 80/1, Kangai Amman Kovil 7622 0862 Nil 1 Years
Street, Pin- 606907 7684
Activity* Existing: Land surveying Since: 18.02.2026
Proposed#: Land surveying
#If a different activity other than the existing activity is proposed/ New unit
16.i)Whether the unit is ZED rated (Yes/No): No
ii) If yes, the gradation obtained by the MSME unit (Tick appropriate one):
Bronze Silver Gold Diamond Platinum
18. Names of Associate Concerns and Nature of Association:
Names of Address of Presently Banking with Nature of Extent of interest
Associate Associate Concerns Association as a Proprietor/
Concerns Partner/ Director
or just Investor in
Associate Concern
- - - - -
19. Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of the Bank
(Please Select): Yes/ No
20. Banking/ Credit Facilities (Existing): (Rupees in Lakhs)
Type of Limit Outstanding Presently Securities Rate of Repayment
Facilities as on Banking Interest Terms
With
Current
Account
Cash
Credit
Term
Loan
LC/ BG
Others
Total - - - - - -
If Banking with our Bank, customer ID be given here: 3011629275
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.
21. Credit Facilities (Proposed)*: (Rupees in Lakhs)
Type of Amount Purpose for which Securities Offered
Facilities required Primary Security (Details with Whether Collateral Security
approx value to be mentioned) offered (If yes, then provide
details on column 23)
Cash Credit**
Term Loan 4.78 Purchase of machinery Hypothecation of Nil
machinery to be purchased
LC/ BG
Others
Total 4.78 - - -
*Mandatory fields
**Basis of Cash Credit limit applied
Projected
Sales Working Inventory Debtors Creditors Other Promoters
Cash
Cycle in Current Contribution
Credit
Months Assets
- - - - - - -
22. In case of Term Loan requirement, the details of the machinery may be given as under:
Type of Purpose for Whether Name of Supplier Total cost of Contribution Loan
Machine/ which required imported or machine being made by the required
Equipment Indigenous promoters
FOIF A90 Land Indigenous JP&SSPL 598000/- 120000/- 478000/-
GNSS surveying
23. Details of Collateral Securities offered, if any, including third party guarantee:
(As per RBI guidelines Banks are not to take collateral security for loans up to Rs. 10.00 Lakhs to MSME Units)
a) Third Party Guarantee:
Sl. No. Name of Father/ Residential Telephone Mobile No. Net Aadhaar PAN
Guarantor Spouse Address No. Worth No. No
Name
1. - - - - - - - -
b) Other Collateral Security:
Sl. No. Name of owner of Collateral Security
collateral Name Details Value (Rupees in
Lakhs)
1. - - - -
24. 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).
Rupees in Past Year 1 Past Year 2 Present Year Next Year Installed Utilized
Lakhs (Actual) (Actual) (Estimate) (Projection) Capacity Capacity
Net Sales - - 9.00 10.50 - -
Net Profit - - 4.45 5.77 - -
Capital (Net - - 3.90 7.80 - -
Worth in
case of
Companies)
25. Status Regarding Statutory Obligations:
Statutory obligations: Remarks (Any details in connection with the relevant obligation to be given)
Whether complied with select Yes/No. If not applicable select N.A.
1. Registration under Shops and Establishment Act Yes -
2. Registration under MSME (Provisional/ Final) Yes -
3. Drug License NA -
4. Latest Sales Tax Return Filed NA -
5. Latest Income Tax Return Filed NA -
6. Any other Statutory dues remaining outstanding No -
26 a) ID Proof (Any of following): PAN Card
.
ID Proof No.: BMAPD0813M
b) Address Proof (Any of following): Electricity Bill
Address Proof No.:
Declaration:
I/We hereby certify/authorize that all information furnished by me/us is true, correct and complete; that
I/We have no borrowing agreements 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/FIs. 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 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/ actions 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.
Place: Vadamathimangalam
Date: 19.06.2026
Signature
‘To be signed at designated branch only’