Annexure I
APPLICATION FORM FOR MSMEs
To be submitted along with documents as per the checklist
( For Office Use)
1 NAME OF THE ENTERPRISE
2 REGD. OFFICE ADDRESS:
3
ADDRESS OF FACTORY/
SHOP/ ADMINISTRATIVE
OFFICE:
4
DATE OF ESTABLISHMENT
/INCORPORATION
5 STATE
DETAILS OF PREMISES:
OWNED/RENTED/
6
LEASED
(In case of Rented /
Leased: Details of Tenant
/lessor and
Rent/document to be
submitted)
Email Address
Telephone No.
( Office)
PAN Card No
Mobile No.
7 CONSTITUTION:
Individual/Joint/Prop. Concern/ Partnership firm/ Pvt. Ltd/
Ltd. Company/ Trust/ Others
8 UDYAM REGISTRATION
NO
8.A
GST REGISTRATION NO &
DATE OF REGISTERATION
8.B ,
REGISTRATION ON GEM
(YES/NO), IF YES THEN
REGISTERATION NO
8.C
,
IMPORTER-EXPORTER
CODE (IEC), IF APPLICABLE
9
CITY /
DISTRICT WHERE LOAN IS
REQUIRED
10 ,
BRANCH WHERE LOAN IS
REQUIRED, If Any
11
NAME OF THE PROPRIETOR/ PARTNERS/ DIRECTORS OF COMPANY AND THEIR ADDRESSES:
S. Name Academic Mobile
No Date of Father / Qualifications No.
Birth Spouse Category SC/ ST/
OBC/ Minority/
Women
S. PAN No. Residential
No Address Aadhar No. / Telephone No. Experience in the
DIN No. (Residence) line of activity
(Years)
Existing since
12. / Proposed (#):
ACTIVITY #
If a different activity other than existing activity is proposed/New Unit
i.
Whether the MSME unit is ZED rated (Yes/No)
ii. ,
13. If Yes,the gradation obtained by the MSME unit (Tick appropriate one)
Bronze Silver Gold Diamond Platinum
14
Names of the Associate concerns and Nature of Association
Name of Addresses of Presently Nature of
Associate Associate Banking Association Extent of interest as a Prop./
Concerns Concerns with Partner/ Director or just investor
in Associate Concern
15.
Relationship of Proprietor/ Partner/ Director with
the officials of the Bank/ Director of the Bank (Yes/No):
,
If Yes, Details to be provided
16. BANKING/ CREDIT FACILITIES (EXISTING):
( Rs. in lacs)
Type of Facilities Securities Rate of
Limit Outstanding Presently Interest Repayment
(in lacs) as on...... banking terms
with
Current Account
Cash Credit
Term Loan
LC/BG
Others
Total
, /
If Banking with our Bank, CIF No. to be given here
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. 16 above.
17. CREDIT FACILITIES (PROPOSED):*
Security
Type of )
Facilities Amount Purpose for
(in lacs) which ,
required Primary
Security (Details with Whether Collateral Security
approx. Value to be offered (Please mention yes or
mentioned) no) (If Yes, then provide details
in column 16 & 19)
Cash Credit
Term Loan
LC/ BG
Others
Total
* Mandatory Fields
18. ,
In case of term loan requirements, the details of machinery may be given as under:
,
Whether , ,
Type of Purpose imported Name of Contributio Loan
Machine / for which or supplier n being required
Equipment required indigenous Total cost of machine (in made by
* case of imported the
machine, the breakup of promoters
basic cost, freight,
insurance and customs
duty may be given)
* ,
* In case of second hand / old machinery, residual life to be incorporated.
19. , ,
Details of Collateral Security offered, if any, including 3 party guarantee*
rd
(*
As per RBI guidelines banks are not to take collateral security for loans upto Rs.10 lakhs
to MSE Units)
a) Third party Guarantee:
S.
No Name of Father/Spouse Residential Telephone Mobile Aad PAN
Guarantor Name Address No. No. Net Worth har No.
(Residence) (in lacs) No.
1
2
3
b) Other collateral Security:
Collateral Security
S. Name of owner of Nature Details
No Collateral Value (Rs. In lacs)
1.
2.
3.
20. PAST PERFORMANCE/ FUTURE ESTIMATES
(
,
Actual performance for 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):
II I
( (
Past Year-II Past Year-I Present Year Next Year
( (Rs. in lacs) (Actual) (Actual) (Estimate) (Projection)
Net Sales
Net Profit
Capital (Net worth in
case of companies)
21. 5 5 Details of Top 5 Suppliers & Top 5 Customers
Name
S. No Contact Number Associated
Since % of Business (Sale
/Purchase) & Credit Terms
22. Status regarding Statutory Obligations:
Statutory Obligation:
Remarks (Any details in Connection with the relevant obligation to be given)
,
Statutory Obligation Whether Complied with (write Yes/ No). If Not
Applicable then write N.A.
1.
Registration under Shops
and Establishment Act
2.
Registration
under MSME (Provisional/ Final)
3. Drug License
4. Latest
Sales tax return filed
5. Latest
Income tax returns filed
6. Any
other statutory dues remaining
outstanding
23. a) ID Proof (Any of the following)
Passport/Voter Identity Card/Pan Card/Driving License/Job Card/Aadhaar Card/Identity Card (subject
to the satisfaction of the bank)
b) 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.
Declaration
,
;
;
.
, ,
,
. ,
;
.
I/ We hereby certify that all information furnished by me/ us is true, correct and complete that I/ We have
no borrowing arrangements for the unit except as indicated in the application; that there is no overdue/
statutory dues against me/us/promoters except as indicated in the application; that no legal action has
been/ is being taken/ initiated against me/us/promoters by any Bank/FIs. I/We shall furnish all other
information that may be required in connection with my/ our application that this may also be exchanged
by you with any agency you may deemed 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 assets, books of accounts etc.
in our factory/ business premises as given above. You may take appropriate safeguards/action for recovery
my/our loan shall be governed by the rules of your Bank which may be in force from time to time.
SPACE FOR PHOTO SPACE FOR PHOTO SPACE FOR PHOTO SPACE FOR PHOTO
Space for Signature Space for Signature Space for Signature Space for Signature
,
SIGNATURES OF PROPRIETOR/ PARTNER/ DIRECTOR WHOSE PHOTO IS AFFIXED ABOVE
Only one photo of proprietor/ each partner/ each working Director is required to be affixed. Each
photo will be certified/ attested by the Branch Team with name and signatures on the photograph
with Branch stamp. The concerned staff will put his name below the signatures.
To be signed at the designated branch only
Documents attached:
I/We
have attached the copies of the following supporting documents (put a wherever applicable)
- ,
Proof of identity- D card/ Passport/ driving licence/ PAN card/ signature identification
from present bankers of proprietor, partner or Director (if a company)
, ,
,
Proof of residence - Recent telephone bills,
ID card of proprietor, partner or Director (if a company)
Proof of business address
Proof of Minority
MSME registration if applicable
2
. , 25
, ,
. 25.00 , .
for all cases from Rs. 2 lacs and above). However, in case of total exposure of the party from all
Banks/ FI is below Rs 25 lakh, if audited balance sheets are not available, then unaudited balance
sheets are also acceptable as per extant instructions of the Bank. For case of Rs 25.00 lakh and
above, the audited balance sheets are necessary.
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 lacs and above)
/ Passport size photograph/s of the applicant/s
Application form
,
Credit information Form of concern/ promoter /guarantors, as applicable
Any other document as per checklist (Please specify)
Date:
Place:
CHECKLIST (For Loan upto Rs.2.00 crore)
1. - ,
.
Proof of Identity-
present bankers of proprietor, partner or Director (if a company).
2. , , ,
Proof of residence - Recent telephone bills,
card of proprietor, partner or Director (if a company)
3. Proof of business address
4.
Applicant should not be defaulter in any Bank / FI.
5. 2
. , 25
, ,
Last three years balance sheets of the units along with income tax / GST returns etc. (Applicable for
all cases from Rs. 2 lacs and above). However, in case of total exposure of the party from all Banks/
FI is below Rs 25 lakh, if audited balance sheets are not available, then unaudited 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 lacs 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 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 GST returns, if applicable
15. 25.00 .
The Audited Balance Sheets are necessary for limit of Rs.25.00 lacs and above.
25.00
For cases with Exposure of Rs.25.00 Lacs and above
16. , , ,
, .
Profile of the unit (includes name 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.
, , , , ,
, , 7 8
, , ,
.
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 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.
19. , , ,
, , ( , , ,
, , .
Review 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 st
outstanding for working capital limits, term loan limits, bills discounted.
20. , , , ,
, ,
.
Manufacturing 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 compa
./
50.00 17, 18, 19
. Data / information at Point No.17, 18, 19 may be sought from unit requesting limit of Rs.50.00Lacs
and above.