Annexure

COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

(To be submitted along with documents as per the check list)

A. For office Use:

Application Sl. No. Name of the Branch

B. Business Information:

Name of the
Applicant /
Enterprise
MSME Micro / Small / Medium
Classification
Proprietary Partnership Pvt. Ltd. Ltd. Company Any Others (pl specify)
Constitution √

Business Business Premises - Existing √ Rented Owned

Address
State PIN Code
Telephone No. Mobile No. 91
Business Premises - Proposed √ Rented Owned

State PIN Code

Telephone No. Mobile No. 91
E-mail /
Alternative E -
mail:
Business Activity Existing
Proposed
Date of Commencement (DD/MM/YYYY)
Whether the Unit is Registered √ Yes No
If Registered (Please mention: Registration
no. And the Act under which registered)
Udyog Aadhar Registration No. **
(** Not Mandatory)
Registered office Address
Social Category √ SC ST Minority Community
 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

If Minority
√ Buddhists Muslims Christians Sikhs Jains Zoroastrians
Community

C. Background Information of Proprietor/ Partners/ Directors of Company and their addresses:

S. Name Date of Birth Academic Experience in the line of
No Qualification activity (Years)

1.
2.

D. Names of Associate Concerns, if any, or Joint Venture (JV) Partner or Director of proposed
Unit:
Names of Address of Presently Nature of Extent of Interest as a Prop.
Associate Associate Banking with Activity of /Partner/ Director or Just Investor
Concern Concern Associate in Associate Concern
Concern

E. (i) Banking/Credit Facilities Existing: (In ` lakh)

Type of Facilities Banks Name and Limit Availed Outstanding

Branch As on ……
Savings Account N. A.
Current Account N. A.
Term Loan
If banking with SIDBI, customer ID 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/we am/are not indebted to any other Bank / Financial Institution other than those
mentioned in column no. E (i)s above.

(ii) Banking/Credit Facilities of associate concerns: (In ` lakh)

Type of Facilities Banks Name and Limit Availed Outstanding

Branch As on ……
Savings Account N. A.
Current Account N. A.
Term Loan
If banking with SIDBI, customer ID to be given here:

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

It is certified that our unit has not availed any loan from any other Bank / Financial Institution in the
past and I/we am/are not indebted to any other Bank / Financial Institution other than those
mentioned in column no. E (ii) above.
N.A – Not Applicable

F. Credit Facilities Proposed:(In ` lakh)**

Type of Facilities Amount Purpose for which Security Offered

Required
Whether Collateral Security Offered (If,
yes, then provide details) (Yes/No)
Term Loan
Cash Credit**
LC/BG
Total
** Mandatory Fields

G. In case of Working Capital: Basis of Cash Credit Limit applied:(In ` lakh)

Projected
Sales Workin Inventory Debtors Creditor Promoter’s Limits
Cash Credit g Cycle s Contribution
in
Months

H. In case of Term Loan requirements, (i) Details of machinery/equipment :

Type of Purpose Name of Total Cost of Contribution being Loan Required
machine for which Supplier Machine made by the (`)
/ Equipment required promoters (`)

Total

(ii) Details of Land:

Type of Land (viz, Address / Area of land Purchase price Estimated Market value
Agricultural, industrial, Location (Sq ft / mtr) of land (`)
commercial, etc) of Land

Total

(iii) Details of Civil Work:

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

Description of civil work Type of Total floor Estimated cost Total cost (`)
constructi Area (Sq ft / per sq ft / sq
on mtr) mtr (`)

Total

Repayment period with Moratorium period required

I. Past financial for last 3 years: (In ` lakh) – In case of existing unit

Particulars FY I FY II FY III
Net Worth
Net Sales
Gross Profit
PAT

J. Future Estimates: (In ` lakh)

Future Estimates (Estimates for current year and projections for first 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)
Current Year First Year Second Year Third Year (Projection)
Particulars (Estimate) (Projection) (Projection)
Net Sales
Net Profit
Capital (Net
Worth in case of
Companies)
DSCR
DER

K. Status Regarding Statutory Obligations:

Whether Remarks
Complied with (Any details in
Statutory Obligations (select Yes/No) connection with the
If not applicable relevant obligation to be
then select N. A. given)
1. Registration under Shops and Establishment Act
2. Registration under MSME (Provisional /Final)
3. Drug License

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

4. Latest Sales Tax Return Filed

5.Latest Income Tax Returns Filed
6. Provident Fund
7. Employee State Insurance Corporation (ESIC)
8. Pollution Control Board (PCB)
a) Consent to establish
b) Consent to Operate
9. Land Use
10. Building Plan Approval
11. Any other Statutory dues remaining
outstanding

L. Declaration:

I/We hereby certify that

all information furnished by me/ us above in this Application/ Business plan & Project
report/Appendix/Annexure/Statements and other papers/ documents enclosed are true and
correct to the best of my/ our knowledge and belief;
I/we have no borrowing arrangements for the applicant enterprise/unit and the associate concerns
with any other bank/FI/ NBFC/ Institution, etc except as indicated in the application;
there are no arrears of statutory dues and no government enquiries/ proceedings/ prosecution/
legal action are pending/ initiated against the enterprise/ unit/ associate concerns/ promoters/
directors/ partners/ proprietor except as indicated in the application;
I/ We also confirm that I/ none of the promoters or directors or partners have at any time declared
themselves as insolvent
I/We have no objection if SIDBI furnishes the information submitted by me/us to other banks / FIs/
CIBIL / RBI/ any other agency as may be deemed fit in connection with consideration of my/our
application for financial assistance.
I/We have no objection to SIDBI/its representatives making necessary enquiries/verifications
(including in CIBIL or any other credit information agencies data base) while considering my/our
application for financial assistance. I/We undertake to furnish all other information that may be
required by SIDBI in connection with my/our application for financial assistance;

(Signatures of Proprietor / all partners / authorized director)

Date:
Place:

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

CHECK LIST

1. Proof of Identity: Voter’s ID Card / Passport / Driving License / PAN Card / Signature
identification from present 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)
Note: As per SIDBI’s KYC application form for Individuals
3. Proof of business Address - As per SIDBI’s KYC application form for Non- Individuals
4. Memorandum and articles of association of the Company / Partnership Deed of partners etc.
5. Bio data of promoters / Guarantors (as per enclosed format I)
6. Net Worth Statement of promoters and guarantors along with latest income tax returns (as
per enclosed format II).
7. Rent Agreement (if business premises on rent) and clearance from pollution control board if
applicable.
8. Udyog Aadhar memorandum (UAM) registration if applicable.
9. 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
10. Photocopies of lease deeds/ title deeds of all the properties being offered as primary and
collateral securities.
11. Documents to establish whether the applicant belongs to SC/ST Category, wherever
applicable.
12. Certificate of incorporation from ROC to establish whether majority stake holding in
the company is in the hands of a person who belongs to SC/ST/Woman category.
11. Profile of the unit (includes names of promoters, other directors in the company, key technical
/ managerial staff, the activity being undertaken addresses of all offices and plants,
shareholding pattern etc.
12. Last three years balance sheets of the Associate / Group Companies (if any).
13. Detailed Project Report (for the proposed project if term funding is required) containing
indicative details of the land, civil works, architect estimate, machinery to be acquired, from
whom to be acquired, price, names of suppliers, financial details like capacity of machines,
capacity of utilization assumed, production, sales, projected profit and loss and balance
sheets for the tenor of the loan, the details of labour, staff to be hired, basis of assumption of
such financial details etc [Furnish Detailed Project Report (DPR) where RAM rating is
applicable and furnish details on profitability projections for the unit as per Format III, in
respect of cases where CART rating is applicable].
14. 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 company’s strength and weaknesses as compared to their
competitors etc.

(The check list is only indicative and not exhaustive and depending upon the local requirements
at different places addition could be made as per (necessity).

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

*****

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

Format I
Bio-data of the Promoters / Guarantors
(Pl affix recent passport
size colour
photograph and sign
across it)

a. Name
b. Father’s/ Husband’s Name
c. Date of Birth
d. Sex (Male/Female/Third Gender)
e. Relationship with chief promoter
f. Whether belongs to Scheduled Castes / Scheduled
Tribes / Minority community
g. Are you Ex-Servicemen
h. Residential Address- Temporary
i. Residential Address- Permanent
j. PAN No
k. Mobile No
l. Telephone No – Office
m. Telephone No – Residence
n. Academic qualifications
o. Professional qualifications
p. Experience
q. Functional responsibilities in the unit
r. Reasons for joining / establishing the unit (please
mention about motivating factors)
s. Family details - Spouse & children (age,
educational background & present occupation)
t. Details of Past Experience of Entrepreneurship
u. Major Skills / Area of Expertise
v. Financial/ capital contribution in all the existing Name of Capital contribution
enterprises/ businesses in which involved as concern/ (` lakh)
promoter/ director/ partner/ proprietor etc (face associate At At present
value only) concerns beginning

w. Functional responsibility in the applicant

enterprise
x. Functional responsibility in the proposed venture
y. Any other relevant information
I declare that the above particulars are true & correct to the best of my knowledge and belief.
(Signature)
Name of the Promoter

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

Format II
Net Worth Statement

1. Name of the promoter/ Guarantor : --------------------------------------

2. Fathers’ name
3. Age and Sex : --------------------------------------
4. Address & Contact Details
Correspondence : --------------------------------------
Residential : --------------------------------------
Permanent : --------------------------------------
5. PAN No. and / or Passport no. : --------------------------------------
6. DETAILS OF ASSETS (` lakh)
i) MOVABLE ASSETS (other than shares held in the applicant enterprise)
a) Cash and Bank (Savings/ FD) :
b) Liquid Shares/ Bonds/ Mutual Funds :
c) Insurance policies (Surrender value):
d) Details of other securities like stake in
unlisted concerns, etc :
e) Vehicles/ Jewellery :
f) Others (kindly specify) :
Total :

ii) Kindly provide details of the pledge

or hypothecation of the above assets :

iii) IMMOVABLE PROPERTIES

Date of Location Whether Land/ Extent of Name of Value Details of
Acquisiti / House/ Flat/ holding joint owner, (` lakh) mortgages,
on Address Commercial/ (%) if any Purchas Mkt. encumbrance
with PIN Agricultural property e price Value

TOTAL

7. DETAILS OF LIABILITIES
S.No Borrowings from Purpose Secured by Amount still to be repaid (`
lakh)
1
2
DETAILS OF GUARANTEES GIVEN
Guarantee given to (name On behalf of/ Guarantee valid Amount involved
of bank/ person) purpose upto (` lakh)
1
2

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

Debit Balance shown in Balance Sheet of any company/ firm in which

you have financial interest/ stake
Any other liabilities
Total Liabilities

8. SUMMARY

Value of Movable assets : ---------------------------------------

Value of immovable properties : ---------------------------------------
Total Assets (` Lakh) : ---------------------------------------

Less: Total liabilities ((` Lakh) : ---------------------------------------

Net Assets (` Lakh) : ---------------------------------------

9. Profit in Business (` Lakh) : ---------------------------------------

10. DECLARATION

I declare that the above particulars are true and correct to the best of my knowledge and belief and I
undertake to furnish such other information as SIDBI may require.

Place : --------------------- Signature: ---------------------

Date : --------------------- Name : ---------------------

CA Certification
Based on the verifications of all the relevant documents/ vouchers/ books of accounts / bank accounts etc. of
Shri/ Smt. ______________________________, we certify that the above information is true & correct to
the best of our knowledge.
Place : --------------------- Signature: ---------------------
Date : --------------------- Name/stamp of the Firm / Partner:
Membership No ---------------------
Note:
1. Net worth details should contain full details of the following:
a. immovable properties including complete address, area (residential, commercial etc.) and whether
they are mortgaged with others with details thereof;
b. movable assets including the details of investments in shares, bonds, debentures, fixed deposits
indicating name of company/ firm, amount, face value, interest rate, etc., and whether they are
pledged with others with details thereof;
c. full details of liabilities including names, amounts, terms etc.;
2. Kindly enclose copies of sale deeds, demat statements of shares, debentures & bonds held, policies, etc.

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

Format III
(Applicable for loans rated under CART in lieu of project report)

Profitability projections for the Unit/ Company as a whole*

S Item Actuals for Y1 Y2 Y3 Y4 Y5

No. previous year

1 Total Income
2 Raw materials
Power and fuel
Wages and salaries
Selling expenses
Other expenses
Total Cost
3 Profit before depreciation,
Interest and taxes (PBDIT)
(2 - 1)
4 Interest on Term Loan
5 Interest on Working
6 Capital
Interest on unsecured
7 loans
Depreciation
8 Profit before Tax (3 - 4 - 5
9 -Tax
6 - 7)

10 Profit after Tax (8 - 9)

11 Dividends/ Withdrawals
12 Cash Accruals (10 - 11 + 7)
13 Repayments of all term
liabilities (Principal)
14 Debt Service Coverage
Ratio ((10+7+4)/(13+4))
15 Average DSCR (Total of
10+7+4 for projected
period/(Total of 13+4 for
projected period)

* Please give projections for the entire tenure of SIDBI loan.

Calculation of DSCR including Escrowable cash flow from rentals***
16 Escrowable cash flow**

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 COMMON LOAN APPLICATION FORM FOR ASSISTANCE UPTO `300 LAKH

17 Total cash flows (16+12)

18 Repayment of all term

liabilities (principal)
19 Debt Service Coverage Ratio
((10+7+4+16)/(18+4))
20 Average DSCR (total of
10+7+4+16) for projected
period /(total of 18+4) for
projected period.

** Escrowable / chargeable cash flow from lease / rental of collateral property (other than owned by
borrower) to be mortgaged to SIDBI to be included in cash accruals at point no 16 above.

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