F347 Form IOB Bank

1
F-347
INDIAN OVERSEAS BANK
ASSETS & LIABILITY STATEMENT
From: To
THE BRANCH MANAGER
INDIAN OVERSEAS BANK
…………………………..BRANCH
Date :
Dear Sir,
Ref. : Application for credit facility submitted

by
for Rs.
.......................................................................................
With reference to the above loan application, I furnish hereunder my personal

information and details of my Assets and Liabilities in Table A and Table D. I also
enclose copies of my Tax Returns / Assessment Order / Salary Certificate /
Encumbrance Certificate of my property for your record.
I hereby declare that the particulars furnished by me hereunder are true to the best of
my knowledge.
Yours faithfully,
Signature
TABLE: A-- PERSONAL INFORMATION

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A.1 NAME AND ADDRESS (WITH

PINCODE)
A.2 Father’s Name / Husband’s Name Sh.

(in case of Married women)
A.3. Date of Birth
A.4. Residential Address & Tel. No.
A.5 Office Address & Tel. No.
A.6 PAN & IT Circle
A.7 Name of Employer / Nature of Business M/s.

/ Profession
A.8 Position held now

A.9 Particulars of Previous employment, if NA
any
A.1 Monthly Emoluments (if in service) NA
0
Cross Income LESS Deductions Net Emoluments
Per Month Rs. Per Month Rs. per Month Rs.
1. 2. 3.
A.11 Earning From Profession/Business

Gross Income Less Expenses Net Earning
Per Annum Rs. Lac
Per Annum Rs. lac Per Annum Rs. Lac
1 2 3
A.12 Name, Address & Tel. No. of my :

present Banker
A.13 Details of Guarantee already executed by me
Name of Principal Name of Guarantee Guarantee Valid Remarks
Debtor Beneficiary Amount upto
1 2 3 4 5
A.14 Details of Credit Cards held

Name of Bank Card Limit Nature of Card Dues as on date
3
1 2 3 4
TABLE: B ASSETS
B. 1 Immovable properties
S.No. Name of the Owner Depreciation Location/Address of Extent of

of Property property (please furnish land
full details with survey No.
Door No. etc.)
1 2 3 4 5
1.
2.
3.
4.
Extent of Building Type of property i.e. whether Details of Date of purchase

area constructed residential / agricultural / documents of property
Industrial / commercial, etc., conferring right
6 7 8 9
Original Purchase cost Present market value Details of encumbrances, if

Rs. Lac Rs. Lac any, on the property
10 11 12
Total
B.2 Machineries
4
Installed at Short Book Value Depreciated Appr. Encumbrance

description Rs. Lac value Market of any
Rs. Lac Value Rs. Lac
1 2 3 4 5 6
B. 3 Deposits held with companies / others
S. Name of the company Nature of Deposit Amount

No. Rs. lac
1 2 3 4
B. 4 Life Insurance Policies
Date of Policy No. Whether Endowment Annual Sum Surrender

policy policy or while life premium Assured Value
policy or other Rs. Rs. Lac (Rs. Lac)
1 2 3 4 5 6
TOTAL
B. 5 Govt. Securities / NSCs / Shares of Listed Companies
S. Description of Security Face Value Market Value

No. (Rs. lac) (Rs. Lac.)
1 2 3 4
1
2
3
4
5
6
7
8
9
TOTAL
B.6 Investments in Business

Sl. No. Name of the company / firm / concern in Amount invested
which investment is made (Rs. Lac)
1 2 3
5
1
2
TOTAL
B.7 Deposits held with Banks

Sl. No. Name of the Bank Nature of Deposits held Amount Deposited
(Rs. lac)
1 2 3 4
1
TOTAL
B.8 Vehicle Owned

Description of Regn. No. Original Depreciated Appr. Market
Vehicle Cost (Rs. lac) Value (Rs. lac) Value Rs. lac
1 2 3 4 5
Insurance company RC book in the name of Encumbrance if any

6 7 8
B. 9 Other Assets Owned
Sl. Nature Description of Original Cost Depreciated Approximate Encumbrance

No. assets Rs. lac value Market Value if any
Rs. lac Rs. Lac
1 2 3 4 5 6
1
2
TOTAL
B.10 TOTAL ASSETS (B.1 TO B.9) : Rs. lac
TABLE : C LIABILITIES
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C.1 Borrowings from Banks and Financial Institution
Nature of the Details of Nature & extent of credit limit / Details of

Institution / Bank facilities enjoyed securities
Nature of Credit facilities Extent (Rs. lac) furnished
1 2.1 2.2 3
NIL
C.2 Borrowings from others
Name of the Lender Amount borrowed (Rs. lac) Details of securities

furnished
1 2 3
Nil
C.3 Other Liabilities

Nature of liabilities Extent of liabilities
(Rs. Lac)
1 2
C.4 TOTAL LIABILITIES (C.1 TO C.3) :
TABLE: D NETWORTH
TOTAL ASSETS TOTAL LIABILITIES NET WORTH

D.1 Rs lacs D.2 Rs. Lac (D.1 minus D.2) Rs. lac
TABLE E: DECLARATION AND UNDERTAKING
E.1 I hereby declare that the assets referred above (Table: B) are owned by me and
these assets are not alienated or encumbered except to the extent furnished in the
statement.
E.2 Further I hereby undertake, not to encumber / alienate the said assets without
prior intimate to Bank in writing till all my obligations to Bank are fully
discharged.
E.3 I/We also declare that I am not facing any litigation initiated by other banks/
financial institutions and there are no recovery proceedings for arrears of Income
Tax, Sales Tax, Customs duty, Excise duty etc. I declare that neither any
insolvency / winding up proceedings nor any court case is pending against me in
my capacity either as borrower or as guarantor.
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(In case any litigation with other bank is faced or winding up proceedings / court case
is pending, the details thereof should be furnished)
Nature of Litigation Brief Particulars
1 2
Nil
E.4 I am agreeable to the condition that your Bank will have unqualified right to
disclose / publish my name is such manner and through such medium as the bank
in their absolute discretion may think fit in the event of default by myself.
Date:
Place: Signature of Borrower
TABLE: F FOR BRANCH USE
1.1 We certify that we have verified the information furnished above, with the
relative records wherever it is applicable and the assessment made is true and
fair to the best of our knowledge and belief.
1.2 Copies of supporting documents as listed here below have been obtained and
held as branch record.
S.No. List of documents / Papers received

1.
2.
Any other remarks:

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1

ASSETS & LIABILITY STATEMENT

Ref. : Application for credit facility submitted

With reference to the above loan application, I furnish hereunder my personal

TABLE: A-- PERSONAL INFORMATION

A.1 NAME AND ADDRESS (WITH

A.2 Father’s Name / Husband’s Name Sh.

A.7 Name of Employer / Nature of Business M/s.

A.8 Position held now

A.11 Earning From Profession/Business

A.12 Name, Address & Tel. No. of my :

A.14 Details of Credit Cards held

S.No. Name of the Owner Depreciation Location/Address of Extent of

Extent of Building Type of property i.e. whether Details of Date of purchase

Original Purchase cost Present market value Details of encumbrances, if

Installed at Short Book Value Depreciated Appr. Encumbrance

B. 3 Deposits held with companies / others

S. Name of the company Nature of Deposit Amount

B. 4 Life Insurance Policies

Date of Policy No. Whether Endowment Annual Sum Surrender

B. 5 Govt. Securities / NSCs / Shares of Listed Companies

S. Description of Security Face Value Market Value

B.6 Investments in Business

B.7 Deposits held with Banks

B.8 Vehicle Owned

Insurance company RC book in the name of Encumbrance if any

B. 9 Other Assets Owned

Sl. Nature Description of Original Cost Depreciated Approximate Encumbrance

B.10 TOTAL ASSETS (B.1 TO B.9) : Rs. lac

C.1 Borrowings from Banks and Financial Institution

Nature of the Details of Nature & extent of credit limit / Details of

C.2 Borrowings from others

Name of the Lender Amount borrowed (Rs. lac) Details of securities

C.3 Other Liabilities

C.4 TOTAL LIABILITIES (C.1 TO C.3) :

TOTAL ASSETS TOTAL LIABILITIES NET WORTH

TABLE E: DECLARATION AND UNDERTAKING

TABLE: F FOR BRANCH USE

S.No. List of documents / Papers received

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