COMMON LOAN APPLICATION FORM

PM-Vidyalaxmi Common Education Loan Application Form

Student ID VLP202507212420092
Application ID A20250721019924292
Date of Application 21-07-2025

1. Personal Information

Field Name Student Parent/Guardian/Spouse Co-obligant / Guarantor

Title Mr Mr NA
First Name Shreyas Maruti NA
Middle Name Maruti Timmayya NA
Last Name Shetti Shetti NA
Father's/Husband's First name Maruti Timmayya NA
Father's/Husband's Middle
Nagappa NA
name
Father's/Husband's Last name Shetti Shetti NA
Date of Birth 19-09-2003 01-05-1962 NA
Category GEN GEN NA
Gender Male Male NA
Religion HINDU HINDU NA
Marital Status Single Married NA
Occupation Student Business NA
10th Marks in Percentage(%) 74 NA NA
NIRMALA HRIDAYA HIGH
10th School NA NA
SCHOOL
12th/Diploma Marks in
74 NA NA
Percentage(%)
GOKHALE CENTANARU P
12th School/Diploma Institute NA NA
U COLLEGE
Education Qualification Completed Under Graduation Completed Under Graduation NA
Marks Obtained in Highest
82.05 NA
Qualification
Annual Family Income 400000 NA NA
PAN No.# ADOPS6954Q NA
Address Line 1 #280-A #280-A NA
Address Line 2 Ankola Ankola Ankola Ankola NA
Village/ Area/ Locality Ankola Ankola NA
Block/Taluka/Sub-
Ankola Ankola NA
district/Town
Landmark NA
District UTTARA KANNADA UTTARA KANNADA NA
State KARNATAKA KARNATAKA NA
PIN 581314 581314 NA
Mobile Number 8884988248 9611522363 NA
SHREYASSHETTI19@GMA SHREYASSHETTI19@GMA
Email NA
[Link] [Link]

Person with
Benchmark N Disability Type Disability Percent
Disability

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. NO

If yes, details of relationship

Present Banker Details

Bank Name STATE BANK OF INDIA STATE BANK OF INDIA NA

POST BAG NO.6 OPP BUS POST BAG NO.6 OPP BUS
STAND ANKOLA DIST STAND ANKOLA DIST
Bank Branch NA
UTTARA KANNADA UTTARA KANNADA
KARNATAKA KARNATAKA
Bank IFSC SBIN0000770 SBIN0000770 NA
Account No. 40859217180 20096745385 NA
Account Type Saving Account Saving Account NA

3. Particulars of course, for which loan is required.

Whether under: Merit / Management

Merit
Quota
Duration of the 2-Year and 0- Date of
16-12-2024 Date of Completion 16-12-2026
Course Months Commencement
Name of the Institution/College: RNSInstituteofTechnology,BANGALORE
Name of the Course: M.C.A. -MASTER OF COMPUTER APPLICATIONS
Prospects of earning after completion of
the course in Rs.:
Registration / Seat Locking Fee:

Cost of Finance Details

4. Cost of Course / Source of Finance: (All amounts are in (Rs))

Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total

TUITION_FE
1.0 350000.0 0.0 0.0 0.0 0.0 350001.0
ES
EXAM_FEES 0.0 0.0 0.0 0.0 0.0 0.0 0.0
BOOKS_STA
0.0 0.0 0.0 0.0 0.0 0.0 0.0
TIONERY
EQUIPMENT 0.0 0.0 0.0 0.0 0.0 0.0 0.0
 _COMPUTE
R
HOSTEL_EX
0.0 0.0 0.0 0.0 0.0 0.0 0.0
PENSES
SUNDRIES_
0.0 0.0 0.0 0.0 0.0 0.0 0.0
TRAVEL
OWN_SOUR
0.0 0.0 0.0 0.0 0.0 0.0 0.0
CE
LOAN_REQ 1.0 350000.0 0.0 0.0 0.0 0.0 350001.0

[Link] of securities offered

[Link] of earning after completion of the course

Repayment proposed No. of Installments Amount(Rs)p.m.

[Link] Documents:

10th Marksheet 0
12th/Diploma Marksheet 0
Proof Of Admission to the course 0
Schedule Of Expenses for the course, as given by institution 0
Applicant Photo 0
Parent Photo 0
Co-obligant / Guarantor Photo 0

I / We declare that all the particulars and information given in the application form are true, correct and complete and binding on me
/ us. Further, the above particulars shall form the basis of any loan Bank may decide to sanction to me / us. The loan amount will be
used for the purpose for which it is granted.

I hereby am giving a consent that I don’t have any objection to receive the communication on WhatsApp/Mobile/Email related to
education loan information/education loan interest subvention information from the Govt of India.

Signature of the Co-

Signature of Student Signature of the Parent/Guardian obligant/Guarantor

Place :

Date :

For Office Use

Credit Report No Date : Customer ID/Application ID:

Repayment Details of Whether eligible
Nature of limit Amount (Rs.) Margin(Rs.) Rate of Interest*
conditions security under CSIS
 including Scheme /
Personal (Yes/No)
Guarantee/Coob
ligation.

Other terms and conditions :

The Bank may revoke in part or in full or withdraw/stop financial assistance at any stage by giving reasonable notice to the
borrower. Credit facilities sanctioned are to be availed within 6 months from the date of this letter, failing which; the limits will
automatically stand cancelled.

Manager/Senior Manager /Chief Manager /Asst Gen Manager Accepted all the terms and conditions of sanction Borrower/s

Form Generated Date : 7/21/2025 6:17:35 PM