Net Worth Certificate Formet

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Annexure 3

Networth of Promoters / Guarantors

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 (Rs ₹)
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) :


g) Advance to Parties :
h) Principal Firm(Borrower) :
i) Other Firm :
Total :

ii) Kindly provide details of the pledge :


or hypothecation of the above assets

iii) IMMOVABLE PROPERTIES


Date of Location / Whether Extent of Name of Value Details of
Acquisitio Address with PIN Land/ House/ holding (%) joint (₹) mortgages,
n Flat/ owner, if Purchase Mkt. encumbranc
Commercial/ any price Value e
Agricultural
property
1
2
3
TOTAL

7. DETAILS OF LIABILITIES
S.No Borrowings from Purpose Secured by Amount still to be repaid
(₹)
1
2
3 Total
DETAILS OF GUARANTEES GIVEN
Guarantee given to (name of On behalf of/ purpose Guarantee valid upto Amount involved
bank/ person) (₹)
1 00

Signature
Name
2 00
Debit Balance shown in Balance Sheet of any company/ firm in which you
have financial interest/ stake
Any other liabilities
Total Liabilities 00

8. SUMMARY

Value of Movable assets :


Value of immovable properties :
Total Assets (₹) :

Less: Total liabilities (₹) :

Net Assets (₹) :

9. Profit in Business (₹) :


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 :

===================================================
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.
*****

Signature
Name

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