NAME OF THE BANK

APPLICATION FORM FOR MSEs

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:

4 WHETHER BELONGS TO SC/ST/OBC/MINORITY

COMMUNITY

TELEPHONE NOs. EMAIL ADDRESS:

(Office)
Mobile No. PAN CARD NO.

5 CONSTITUTION Propritory/Partnership firm/Pvt. Ltd./Ltd. Company/Co-op. Society

6 DATE OF
ESTABLISHMENT :

7 NAME OF PROPRIETOR/PARTNERS/DIRECTORS OF COMPANY AND THEIR ADDRESSES:

NAME AGE ACADEMIC RESIDENTIAL ADDRESS TELEPHONE NO. EXPERIENCE IN

QUALIFICATIONS (Residence) THE LINE OF
ACTIVITY

1
8 ACTIVITY : Existing :

Proposed (#):

# If a different activity other than existing activity is proposed.

9 NAMES OF ASSOCIATE CONCERNS AND NATURE OF ASSOCIATION:

NAME OF ASSOCIATE CONCERN ADDRESSES OF PRESENTLY NATURE OF EXTENT OF INTEREST AS A PROP. /

ASSOCIATE BANKING WITH ASSOCIATION PARTNER / DIRECTOR OR JUST INVESTOR
CONCERNS IN ASSOCIATE CONCERN

10 Relationship of Proprietor/Partner/Director with the officials of the Bank/Director of the

Bank

10(a) CREDIT FACILITIES (EXISTING) : (Rs. in lacs)

Type of facilities Limit (In lacs) Outstandings as on….. Presently banking with Security Lodged Rate of Interest Repayment terms

Current account
Cash Credit
Term Loan
LC/BG
If Banking with this Bank, customer No. be given here.

10(b) 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 10(a) above.

11 CREDIT FACILITIES(PROPOSED):
Type of facilities Amount (In Purpose for which Security offered
lacs) required

PRIMARY SECURITY (Details with approx. value Whether Collateral Security offered (Please
to be mentioned) mention yes or no) (If yes, then provide details in
column 12)

Cash Credit YES / NO

Term Loan YES / NO

LC/BG YES / NO

In case of term loan requirements, the details of machinery may be given as under:
Type of Machine Purpose for Whether imported or Name of supplier Total cost of machine (in Contribution being made by Loan required
which required indigenous case of imported machine, the promoters
the breakup of basic cost,
freight, insurance and
customs duty may be
given)
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12 Details of Collateral Security offered, if any,including 3rd party guarantee *

(* As per RBI guidelines banks are not to take collateral security for loans upto Rs. 5 lakhs to MSME Units)

13 PAST PERFORMANCE/FUTURE ESTIMATES (Actual performace for two 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):

PAST YEAR - II PAST YEAR - I (Actual) PRESENT YEAR NEXT YEAR (Projections)
(Rs. in lacs) (Actual) (Estimates)
Net Sales

Net Profit

Capital(Net worth in case of companies)

14 Status regarding Statutory Obligations:

Statutory Obligation Whether Complied with (Write Yes / No ). If Not Remarks (Any details in connection with the relevant obligation to be given)
applicable then write N.A.

1. Registration under Shops and

Establishment Act
2. Registration under SSI (Provisional /
Final)

3. Drug Licence

4. Latest Sales tax return filed

5. Latest Income tax returns filed

6. Any other statutory dues remaining

outstanding

15 SPACE FOR PHOTO SPACE FOR PHOTO SPACE FOR PHOTO

SIGNATURES OF PROPRIETOR / PARTNER / DIRECTOR WHOSE PHOTO IS AFFIXED ABOVE

Only one photo of properitor / 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.

16 Date : Place:

I/We certify that all information furnished by me/us is true; that I/We have no borrowing arrangements for the unit except as indicated in the
application; that there is no overdues/statutory dues against me/us/promoters except as indicated in the application; that no legal action has been/is
being taken against me/us/promoters; that I/We shall furnish all other information that may be required by you 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, representatives of the Reserve
Bank of India or any other agency as authorised by you, may, at any time, inspect/verify my/our assets, books of account etc. in our factory/business
premises as given above.
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CHECK LIST (TO BE GIVEN TO THE NEW CUSTOMERS BY BRANCH) OF DATA TO BE KEPT READY BY
THE CUSTOMER

1 Proof of identity – Voter’s ID Card / Passport /driving licence / PAN Card / signature identification from present bankers of proprietor, partner or
Director (if a company).

2 Proof of residence – Recent telephone bills, electricity bill, property tax receipt / passport / voter’s ID Card of proprietor, partner or Director (if a
company).
3 Proof of business address
4 Proof of Minority
5 * Last three years balance sheets of the units alongwith income tax /sales tax returns etc. (Applicable for all cases from Rs.2 lacs and above).
However, for cases below fund based limits of Rs.25 lacs if audited balance sheets are not available, then unaudited balance sheets are also acceptable
as per extant instructions of the bank. For cases of Rs.25 lacs and above, the audited balance sheets are necessary.

6 * Memorandum and articles of association of the Company/Partnership Deed of partners etc.

7 * Assets and liabilities statement of promoters and guarantors alongwith latest income tax returns.

8 * Rent Agreement (if business premises on rent) and clearance from pollution control board if applicable.

9 * SSI 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 alongwith
detailed terms and conditions.

12 * Profile of the unit (includes names of promoters, other directors in the company, the activity being undertaken,addresses of all offices and plants,
shareholding pattren etc. (APPLICABLE FOR CASES
WITH EXPOSURE ABOVE Rs.25 LACS).

13 * Last three years balance sheets of the Associate/Group Companies (If any).
(APPLICABLE FOR CASES WITH EXPOSURE ABOVE Rs.25 LACS).

14 * 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 utilisation assumed, production, sales, projected profit and loss and
balance sheets for the next 7to 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. (APPLICABLE FOR CASES WITH EXPOSURE ABOVE Rs.25 LACS).

15 * Review of account containing monthwise sales (quantity and value both), production (quantity and value), imported raw material(quantity and
value), indigenous raw material (quantity and value), value of stocks in process, finished goods (quantity and value), debtors, creditors, bank's
outstandings for working capital limits, term loan limits, bills discounted. (APPLICABLE FOR
CASES WITH EXPOSURE ABOVE Rs.25 LACS).

16 * Photocopies of lease deeds/title deeds of all the properties being offered as primary and collateral securities.

17 * Position of accounts from the existing bankers and confirmation about the asset being Standard with them (In case of takeover).
18 * Manufacturing process if applicable, major profile of executives in the company, any tieups, details about raw material used and their suppliers,
details about the buyers, details about major competitors and the company's strength and weeknesses as compared to their competitors etc.
(APPLICABLE FOR CASES WITH EXPOSURE ABOVE Rs.25 LACS).

(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)