Application for Pradhan Mantri Mudra Yojana Loan upto Rs.10.
00 Lakh
1. Name of the Enterprise* M/S. GAFFAR SHAIKH
2. Regd. Office Address: VILL.- BHAGABATIPUR, P.O.- BHIMPUR, PS.- MURARAI, DIST.-
BIRBHUM, PIN-731219
3. Address of Factory/Shop*
Photograph to
VILL.- BHAGABATIPUR, P.O.- BHIMPUR, PS.- MURARAI,
be pasted at the
DIST.- BIRBHUM, PIN-731219
time of signing
4. Whether Belongs to SC/ST/OBC/Minority Community: Yes/No
of the
If Yes, then Please Select: SC/ ST/ OBC/Minority Community
application in the
designated
5. Telephone No.
branch.
6. E mail Address*
7. Mobile No.*
8. PAN Card No. DURPS9486Q
9. Constitution (Please Select)* Individual/ Joint/ Prop. Concern/Partnership/ Pvt Ltd Co/
Limited Co/ Trust/ others
10. Date of Establishment*
11. State * WEST BENGAL
12. City where loan is required* BIRBHUM District: BIRBHUM
13. Branch where loan is required. (If any) NANDIGRAM BRANCH, BIRBHUM
14. Name of Proprietress/ Partners/ Directors of Company and Their Addresses: *
[Link] Name Date of Father/ Academic Mobile No
Birth Spouse Qualification
1. GAFFAR 06/06/1988 JANAB ALI
SHAIKH SHAIKH
[Link]. PAN No. Residential Address Telephone Experience in the
No. line of activity
(Residence) (Years)
1. DURPS9486Q VILL.- BHAGABATIPUR, P.O.- BHIMPUR,
PS.- MURARAI, DIST.- BIRBHUM, PIN-
731219
15. Activity* Existing YES since EXISTING
Proposed# NA
-2-
#if a different activity other than existing activity is proposed.
16. Names of Associate Concerns and Nature of Association: NA
Names of Address of Presently Nature of Extent of
Associate Associate Banking With Association Interest as a
Concerns Concerns Prop./ Partner/
Director or Just
Investor in
Associate
Concern
Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of the
Bank: Please select (Yes/ No)
17. Banking/Credit Facilities (Existing) (Rs. in lakh)
Type of Limit (in Outstanding Presently Securities Rate of Repayment
Facilities lakh) 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:
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. 17 above.
18. Credit Facilities (Proposed)*
Type of Amount (in Purpose for which Primary Security(Details with
Facilities lakh) Required approx. value to be mentioned)
OVERDRAFT
Working 5 Lakh To meet the HYP OF STOCK BOOK
Capital Term Working Capital DEBTS
Loan Require
LC/BG
Others
Total 5 Lakh
*Mandatory Fields
-3-
**Basis of Cash Credit Limit applied
Cash Projected
Credit Sales Working Inventory Debtors Creditors Other Promoters
Cycle in current Contribution
months assets
- -- --
19. In case of term loan requirements, the details of machinery may be given as under:
Type of Purpose Whether Name of Total Cost Contribution Loan
Machine/ for which Imported Supplier of being made Required
Equipment Required or Machine & by the
Indigenous STOCK promoters
20. Past Performance / Future Estimates
Past Performance / Future Estimates (Actual performance for two previous years,
estimatesfor 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)
Rs. in lakh Past Year Previous Year Present Year Next Year
31-03-2024 31-03-2025 31-03-2026 31-03-2027
Net Sales - 1,66,800.00 22,00,000.00 25,00,000.00
Net Profit 35,200.00 45,120.00 2,50,000.00 3,00,000.00
Capital (Net 35,200.00 2,88,474.00 4,87,323.00 6,99,287.00
Worth in case
of Companies)
22. Status Regarding Statutory Obligations:
Statutory Obligation: Remarks( Any details in Connection with the relevant obligation to be
given)
Whether Complied with (select Yes /No). If not applicable then select N. A.
1. Registration under Shops and Establishment ACT Yes/ No/ NA YES
2. Registration under MSME (Provisional /Final) Yes/ No/ NA
3. Drug License Yes/ No/ NA
4. Latest Sales Tax Return Filed Yes/ No/ NA
[Link] Income Tax Returns Filed Yes/ No/ NA
[Link] other Statutory dues remaining outstanding Yes/ No/ NA
22. a.) ID Proof (Any of following): Passport/ Voter Identity Card/ PAN Card/ Driving
Licence/ Job Card/ Aadhaar Card/ Identity Card (subject to the satisfaction of bank)
ID Proof No. DURPS9486Q
-4-
b.) Address Proof (Any of 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/ Aadhaar Card
Address Proof No: 7589 1835 9478
Declaration:
I/We hereby certify that all information furnished by me/us is true; that I/We have no
borrowing arrangements 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
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 authorised by you, may at
any time, inspect/ verify my/our assessment of account etc. in our factory/business premises
as given above.
Signature:
GAFFAR SHAIKH
(Proprietress)
To be signed at the designated branch only’
Date:
Place:
CHECK LIST
1. Proof of Identity : Voter’s ID Card / Passport / Driving License / PAN Card / Signature
identification from preset bankers of proprietor, partner of director ( if a company)
2. Proof of residence: Recent telephone bills, electricity bill, property tax receipt /Passport /
voter’s ID Card of Proprietor, partner of Director (if a company)
3. Proof of business Address
4. Applicant should not be defaulter in any Bank/F.I.
5. Last three years (Audited or Unaudited )Balance Sheets of the units along with income tax /
sales tax returns etc. (Applicable for all cases from Rs. 2 lakh and above)
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 lakh and above).
11. Photocopies of lease deeds/ title deeds of all the properties being offered as primary