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 PleaseTick (/) One of No.l and any one of Numb6r 2

I Male F€male 2 Gen sc ST oBc Minority Ex-Serviceman PH HBA

Bank
H.O./C.O.

ffO BE FILLED IN BLOCK LDTTERSOR TYPED)

From :- Full PostalAddressofthe Branch
The Branch Manager,
..... Branch Vill./Town :
.......Tehsil Road :
District pin
P.O......,.....................
State District:
State:
Ref. No. Date:

To
The Secretary
RajasthanKhadi & VI. BoarC
JLN Marg
JAIPUR

(THROUGH THE FINANCING BANK's NODAL BRANCH)

Sub :- Paymentof "Govt. Subsidv" rgsirsl the Bark Financesarctiofled under

Sir,

Seoetary / Chairman / President/ Managing Trustee / Proprietor of

herebyinform thata VillageIndustryprojecthasbeensanctionedin my / our favourunderthe

Stato
ef..................
DetailsofProject Cost Amornt (Rs.) MeansofFinancc Amount(Rs.)
A) Capital Expenditure r Owr Cortdbution
(i) Workshed
(ii) Machinery/Equipment Term Loan for Fixcd Capital
B) Working Capital CashCredit for Working Capital
TOTAL (Rs.) TOTAL(ns.)
Note : l. Cost of land should not be included in the Capital Expenditureunder the Foject cost.
2. Total cost ofthe project should not exceedRs. 25.00 lakkhs for manufacturingand
Rs. 10.00Lakhs for Business/ ServiceSector.

Signatur"of thc b€neliciary Contd...-.21-

 .2:
2. I / We,th€r€fore youto pleaseadvisetheBankto disburse
request an amountof Rs.......................................

my /ourprojectis asunder.
2.1 (a) FullNameofthe beneficiary/ Society/ Institution/ Trust
(b) Father's
Name(ln caseoflndividual)
(c) Dateof Birth of individual
(d) FullAddress(with PinCode)
(e) LcgalStatus/Constitution
(Partnershipfirm not eligibl€)
(0 Registration No. and date,i fany
2.2 Locationofth€Unit
(Village,Taluka,[Link] PinCode)

2.3 VillageIndustryActivity(Pleasespecify)

2.4 (a) GeneralCategory

or Y E S iN O
(b) Whetherthebeneficiarybelongsto SC/STMinority
/OBC/Ex-Serviceman/PHC/women/HBA.
(Please
specify)

z.:r PerCapltal'rxedInveslmenl Rs.

(C.E,dividedby fulltimeenrployment
equalto
Rs.1,00,000)

2.6 Employment :-
envisaged a)Fulltime

' 2.7 Particula6ofdepositof a)NatureofDeposit SB/CD

owncontribution b)AccountNo.
c) Dateofd€posit
d)Amountdeposited Rs.

2.8 Bank'sSanction
LetterNo.: (Copyofsanction
ordertobeenclosed)
DateofSanction

2.9 Dateandamountoffirstdisbursement
(Certilied copyofledger ertrscts to beenclosed)

2.l0Wheth€rthesanctionis coveredunderCredit
GuaranteeFundSchemeforMicro,Small IndustriesofCGTMSE
:

3. I / Weherebyagr€eto abideby thetermsandconditionsandinstructionsissuedby theKhadi& V L Commissionin this behalffrom

time to time and thoseto be issuedin futur€with regardto PMEGP I/We also agreeto furnish ouarterlv prosressreport on
[Link] €tc. to the Bank which ir turn will sendthe information on ouarterlv basisto th€
R8j. Khadi& V.L Bosrd forrecord and further information.
4. I / Weh€rebydeclarethattheGovi. Subsidyhasnot beenclaimedeitherby m€or by anyotherp€rsonofmy family forthe sameor any
otherProjectin the pastand "one frmily onc subsidy" nom [Link],the Bank credit hasnot been/willnot be
utilized to adjustor squareolIany previousloar/advancctakenby me/ ush the past.

(activity/indqstry) is a newVillageIndustryuritand notanexistingunit.

6. lt is alsocertifiedthattheunit locatedat theaddress mentionedin [Link] inmynameonlyand I amthesoleproprietorof
this unit. It is alsodeclaredthat, it is not a Partnership Firm / PrivateCompanyetc.

Signaturcof the beneficiary Conld.....3/-

-'--------

t 5 :

7 . Certift€dthat I / We have alreadyundergonenecessaryEDP Trainingof .-.................... Days / Months during

conducted
theyear..................-.......-................ by ......

the tnining institute).

Certified that I / Weshall display following sign-boardat themain entranccofmy / our projcct site i

(Unitname)
............

Financed
by......-.....-

of MoMSME
UnderPMEGPScheme

I / Wearereadyto bearthe a ouotofcuaranto€feeandAnnualServicefge in respectofcredit GuaranteeFundSchemefor Micro,

ShallIndustriesoperatedby CCTMSE,ifthe Bankin itsdisFetiondecidesto r€coverthesame.

amountofcovt. subsidy calculatedonworting capitalloan/ cashcreditfacility,ifth€

10. I / We,herebyundenaketo refundproportionate
saidWC Loan/ CC facility is not ad€quatelyutilizedasper stipulatrdnormsof KVIC. The averageutilizationof workingcapital
ofthe sanctioned
duing the first yearofoperationofthe unit shouldnot bc lessthan75olo limit andthe limit shouldtouchat leastooe

peaklevel ut il izstion of I 00% with in threeyears'p€riodbeforethe Govt. Subsidy amountis adjustedwith the loanamount.

ti. lt f lereby dcclarcd that rll fscts [Link] by nelus in lhe Govt SubsktyclNimsr€ correct rDd ifany irformrtkm is

found to b€ frlse or leadsto misguiding the .uthoriticr with ulterior motive of availlng Govt. Subsidy, I r' W€ should be

s[bjected to rny purishment rs d€Gmedlit in the €yesoflsw.

12. TheAdvanceStampReo€iptofcovt. Subsidyamountis alsoattach€d.

Yoursfaithtully,

Place:

Datc: Signaturcof the Beneficiary

SEAL

COUNTERSIGNED

BRANCHMANAGER

(Scalofthc BankBranch)
 RECEIPT

thc ChiefExecutiveOfficer,Khadi and Village IndushiesCommissionMumbai-56,towardsth€ paymentof "Govt. Subsidy"in

(Revenue
StamP)
(Signatureof theApplicant)
Noter In caseofe Co-operstiveSociety/Instiluion,Seslhasto b€8flixed.

(For the use of the Bank/Branch)

l. ln considention of the project of the above beneficiary/ lnstitution, our Bank / Branch has sanctioneda loan of
Rs.......................................[Link].............
[Link]..........................................) theBankhasreleased
(C.E:Rs..........,,.........-.................... / lull lumpsum
firstinstalltrlent
a m o u n6tf l o a no f R s .........on......,..................................TheBankshallarrangetodepositth
[Link] TermDepositin thenameofthe beneficiaryfor 3 yearsfrom thedateofreleaseoffirst installmentofthe loan.
It is confirmedthat no interestwill be paid on the amountof TDR by the Bank and no interestwill be chargedon the
corresponding amountofthe loanfor aperiodof3 [Link] Bankis aware,thatifthe advancegoes"bad"befbre3 years,Covt.
Subsidywill be adjustedto liquidateloan liability of the beneficiarywith [Link],if any,effectedlater will be
remittedto thecommission.

Certifiedthatlheunitsanction by ourBankBranchin favourofShri/SmtAiVs. ............

is a new unit and not an existingunit. The instantGovt. Subsidyclaim is in conformitywith the guidelinesand instructions
issuedby RBI, KvlC andour [Link] instantprojecthasnot beensanctioned for utilization,iadjustmentpartl; or wholll', of
anydebtdeemedbador doubtfulofrecoveryorto adjust/ liquidateany past /
loan advance.

3 . Certifiedcopli of the Sanctionorderofthe Bank andcertifiedledeerextractsof theborrower'sTemrloanA./candCashcredit

accountis/areenclosed.

wife of .,..............-.. ..... has beenundergone

EDP traininsand a cop] of the
certificateis enclosed.

5 . Certifrid that the unit sanctionedby our B ankBranchin favour of Shri/Smt/M/s./Kum/.

ang Covt. Subsidyamountreleasedto the unit will be propotionatelyrecoveredand remittedto KVIC if th€ unit doesnot
adequatclyutilizethe WC/CCfacility asper KVIC norm [Link] WC duringthe first yearofoperationof
thc unitshouldnot be lessthan75%ofthe sanctioned limit andthe limit shouldtouchatleastonepeaklevelutilizationof 100%
within 3 years'periodbeforethe 6ovt. subsidy amoult is adjustedw ith the loanamount.

(Signature)
Plece: (Designationofthe Bank Oflicial)
Drc: (SealoftheEank)
Enclosulrs:
Asrbovc. SignaturcCode/P.A. No................
 TO BE STAMPEDAS AN AGREEMET{T
AS PERTIIE STATESTAMPACT IN FORCf,

r rTTf,R, OTUNDI'RTAKINGIrIEE{Iq{E4
EX:TFEBORROWER
UNDERKVIC-PMEGP
FINAITCf,

To,
Thc Bnncb Manager,

l/Wehavebeensanctioned
wirh a lorn for Rs. (Rupees
for which necessary
documentshavebcencxecutedby mey'us.
vwc shar becomeerigiblefor Ma3in
M;ncy Assistmceof Rs. (Rupe€s
underthc abovc
schemconly 8fter KvIc aprov€s ny/cb cligibility for the Mrrgin Mon€[Link]
approval& admissionofthe ctaimby KVIC thc
MnrginMoneysubsidylmout|t mayb€rttainedin aTermDcpoohAccoulrtwith
thcBankin my/ournamefor threeyearswio licn ma*cd
forth€losnsEnctioned.
ln c'"€ ofnon-ldmbsion/ nonrpprovalofclaimbyKv tc th€Bankshall
beentithdto.
{a) Rctundthesubsidyin fu[ to rbeKVIC.
(bj Toconventhcsrnctioni ooneorthedher
ofits [Link]€nceto mein rhisrcgard.
(c) -lfurthcr
undenake
to bindmyselfmdrbldcbythedecisions/acdons tskenbytheBankio thisrg3ait asaforcsaid.

Yoursfaithfully,

Datc:

. Signat re of Dororver
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 On StampPaperofValueRs. 15i-

AIfiPAVTT

S/oShri Permanent
R/o Village PO. District
State

I solemnlydeclaredthat the informationsubmittedto KVIC/KVIB/DIC is correctin aUresp€ctup to the bestofmy lnowledge and

belief. FurtherI declarethat :-

1. I amProminentpenon ofthe societyandat presentthereis no liability pendingagainstm€for anyGow. Deparbnent/Co-operative

Soci€tyandindividual firms aswell astherein no anytrial pendingor underconsiderationwith crimeor fraud.

2. [Link].
3. I amapplyingfor loanunderPMEGpscheme.
4. I wi II setup theunit in therural areacertifi€dby therBvenuedeparEnentin th€Village PO
_
Tehsil Dist State
5. I will setupa newunit aftergettinglosnfrom bankunderPMEGPandwill not manipulatein anyrespectwitli old units.
6. I will abidecompletelyby therulesandregulatioms
laid downunderpMEGp scheme.
?' I will allow andco-operatethe [Link] to inspeatmy unit installedunderPMEGPscheme& duringthe in$pectionifthere is
any irreguladty or manipulationfound by KVIC/KVIB/DIC Officials, the [Link] authority to recoverthe
Margin Moneywith interest.
8. I will usetheloanamountunderPMEGPfor setingup tbeunit for wiich it is takenandwill notmis-utiliz€ it.
9. I will submittheprogressreportofthe unit seaup und€TPMEGP
slchemeto KVIC/RKVIB/DIC asthecasemy be,regularlyin time
. withoutfail.
10.1will befully responsiblefor anytypeofmisutilisationofthe loanunderpMEGpscheme.
I I Myselfor anyofmy family membershavenot availedanyfinancialassistance
underREGP,pMRy or anyotherschemeofcovt. of
hdia or StateGovemmedtscheme.
[Link]€d/ appliedforanysubsidyfiom anyotherDepartne forthepropos€dunit.

(DEPONENT)
Witness. l.

2. Signature
 T'NDERTAXING

underhke to dcposit own contibution in

(Name,address& [Link]. of Bankwhichwill financaproject) [Link].

Address

r
 I'NDERTN,KING

undedake to deposit own contibution in

(Name, address& Ph. No. of Bank which will finance project)

Ph. No.

Yoursfaithfirlly

Signature
ofapplicant
Name

Address

Place:
Date: