SAMPLE ONLY

Application Form

(Document / Information / Data Requirement as per Appendix-II)

Facility Required (Corporate/Personal Loan)

Amount (Rs. Crore)
Purpose
Tenor and Repayment
Security
Contact Person (Name, Designation, E-Mail
and Mobile No.)

1. Particulars of the Company incl. brief history of the company and the unit:
a) Name of the Applicant Company
b) Promoters
c) Constitution
d) Sector
e) Nature of business
f) Registered/Corporate Office
g) Year of incorporation
h) Lead Lender

2. a. A brief paragraph on the Background/Activities of the borrower

b. A brief paragraph on the Background of Promoter

c. Details about end use of fund

d. A brief background of the Group Companies and their Financials

3. Stake of Institutions and Banks

(a) Term Loans (Rs. in crore)
Division Name of Amt. Sanc. Intt. Amt. I. Amount
Instt./ (Year) Rate Disb. Security created
O/s
Banks %
As on ………….
Principal Intt.

(b) Working Capital Loans (Rs. in crore)

Facilities Drawing Power Outstanding
Sanctioned as on …………………
Name of the Fund Non Margin/ Fund Non Fund Fund Non Fund Rate of Intt.
Bank Based Fund Share Based Based Based Based (in %)
Based (in %)

(c) Repayment Schedule (During IFCI’s tenure of Loan/Facility) (Rs. in crore)

Name of FY 1 FY 2 FY 3 FY 4
the Bank

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4. Capital Structure of Borrower (As on ………………….) (Rs. in crore)
Authorised Issued, Subscribed &
Share Capital
Capital paid up

Total

(Rs. in crore)
Particulars (Equity) Amount % holding
Promoters
Banks and Insurance company
FIIs (*)
Other corporate bodies
Public
Others
Total

Particulars (Preference) Amount % holding

Promoters
Banks and Insurance cos.
Total
(*) Details of FIIs and Body Corporate

5. a. Details with regard to Directors (as on ……………………)

Name Age Designation PAN CARD No. Promoter/Executive/I Brief Background

ndependent

b. Details with regard to Management (as on …………)

Name Age Designation Function/Department Brief Background

6. Details and present status of major pending litigation's against the Company.

7. Note on compliance of statutory liabilities and outstanding dues, if any.

8. Past Working results and financial position (Rs. in crore)

WORKING RESULTS
FY1 FY2 FY3 FY4
(for the year ended 31 March )
Net Sales
Gross Profit
GP Margin (%)
Depreciation
Misc.Expences written off
Financial charges
Operating Profit/ (Loss)
OP Margin (%)

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WORKING RESULTS
FY1 FY2 FY3 FY4
(for the year ended 31 March )
Other Income
PBT
Tax
PAT
Net Profit margin (%)
Gross Cash Accruals
Total Dividend
Dividend (%) on Equity
Net cash Accruals
FINANCIAL POSITION
(as on 31 March )
Gross Block
Less: Depreciation
Net Fixed Assets
Capital W-I-P
Secured Term Loans
Unsecured Loans
Investments
Current Assets
Current Liabilities
Bank Borrowings
Net Worth
Equity capital
Preference Share Capital
Reserves
Less: Misc. Exp. not W/off
Net Worth
Debt Equity Ratio
Current Ratio
FACR

9. Projected Profitability projections, funds flow and balance sheet for the company
along with assumptions. All assumptions need to be explained and supported with
the help of relevant documents.

Please furnish excel sheet with links and summary of assumptions.

10. Security :
a) Tangible Security – Please mention property details (Land Area in acre/sq mtr, nearby
landmarks, construction/buildings, land use etc.)
b) If the security is by way of pledge of listed shares then
 A brief paragraph on the background/activities of the share pledgor.
 Certificate from Chartered Accountant that the Credit record of the company
whose shares are being pledged is satisfactory and there are no defaults as on
…………. for both term loans and working capital.
 The trading Volume of the share per day and the number of days required to
recovery the loan amount.
c) Pledge of shares of both listed and unlisted Companies
d) Personal properties of promoters/their relatives/group companies of the assisted
concerns (excluding vacant land)
e) Corporate Guarantee
f) Personal guarantee

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 g) Escrow of receivables of borrower company/group company/project specific receivables
h) Assignment of Project Documents/Insurance Policies / Contract Claims and any other
claims from Suppliers of Equipment, etc.
i) Land
j) Legally Binding Comfort Letter from Group Company
k) Lien on Fixed Deposit Receipts (FDRs) pertaining to Term Deposits with Scheduled
Commercial Banks
l) Security Deposit with IFCI
m) Post Dated Cheques (PDCs)

11. Risk adjusted return matrix

Internal Credit Risk Rating Rate of Interest Front End Fee

(Borrower & Security) (annualized) (on sanctioned amount)
CR 1 BR + [0.25% - 0.75%] 0.25% - 0.50%
CR 2 BR + [0.50% - 1.00%] 0.50% - 0.75%
CR 3 BR + [1.00% - 1.75%] 0.75% - 1.00%
CR 4 BR + [1.75% - 2.00%] 1.00% - 1.50%
CR 5 BR + [2.00% - 2.50%] 1.50% - 2.00%
CR 6 BR + [2.25% - 3.00%] 2.00% - 2.50%

However, where there are some risk perceptions which cannot be quantified, IFCI Venture
reserves the right to change the interest rate accordingly. The rate of Interest shall be
annualized rates so that the borrower is aware of the exact rates that would be charged.

Note:

 All the data in the application form needs to be the latest information available
with the company.

***

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 Appendix-II

INFORMATION/DATA/DOCUMENT REQUIREMENT WITH APPLICATION

S.N Requirement Check Box

01 External credit rating - Long term debt; agency, rating, date, amount Rs. Cr

02 External credit rating - Short term debt; agency, rating, date, amount Rs. Cr

03 Restructuring/Re-schedulement/Deferment/Relief and Concessions availed by the

company/Group concern in the past, if any

04 Audited financial results of borrower concern as well as company whose shares are
proposed to be pledged – Last Three Years and quarters

05 Audited financial results of the company whose shares are proposed to be pledged
(Applicable if shares are offered as security) - – Last Three Years and quarters

06 Terms of unsecured loans, if any

07 FC debt if any including ECBs, FCCBs etc. along with detailed terms, if any

08 Convertible debt contracted by the company along with terms, if any

09 Contingent liabilities (if any), details

10 Arrears in Statutory Payments (if any) Income tax, sales tax, service tax, PF, ESI, others

11 Name, address and contact details of bankers and lenders along with details of debt
sanctioned, disbursed, O/s, rate of interest, security, year-wise repayment schedule -
principal and interest, and overdues (amount and since when), if any

12 Bankers’ feedback on company's/ group concerns accounts

SECURITY RELATED DOCUMENTS

S.N Requirement Check Box

01 Latest Valuation reports (date, distress valuation, agency) of assets, ownership
documents, unencumbered, right to transfer, mutation, land use, marketability, access
rights, etc.
02 PAN Card, proof of address and networth details of proposed Guarantors in IFCI format
(Annexure-1) duly certified by CA firm

03 Last 3 year IT/Wealth tax returns of personal guarantors certified by a CA firm

04 Details of guarantees extended by Corporate Guarantor

05 Networth details and external rating of corporate guarantor

PROJECT RELATED DOCUMENTS

S.N Requirement Check Box

01 Copies of the DPRs which would have been prepared by the project Consultants to
examine and satisfy on the technical/commercial viability of the projects.

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S.N Requirement Check Box

02 Present order book positions, past track record and capability of the contractors appointed
to carry out various works, to meet their delivery commitments in a timely manner.

03 Periodic progress reports on project implementation and status of pending clearances.

During project implementation, reports/documents to assess project progress vis-a-vis the
initial cost and time estimates and to determine the effect of variations from schedule on
the project cost.

04 Comparison of capital cost as also the variable costs with other similar projects to assess
competitiveness.

05 Latest 2 reports of lenders' as well as Owner’s Engineer, if any

06 Copy of Environmental Impact Assessment Study, if any, to understand any environment

related issues/concerns and the mitigants which may have been put in place to tackle
these concerns may be assessed.

07 Requirement of land for the project and status of its acquisition

08 Appropriate and adequacy of insurance for all assets and third party damages, during
project execution phases, if any.

OTHER DOCUMENTS

S.N Requirement Check Box

01 Names of the promoters, directors and their associate concerns are not appearing in the
RBI caution/willful defaulter/CIBIL list.

02 List of Board of Directors with age, brief background, DIN No., PAN No., correspondence
address and mobile number

03 Details of any outstanding litigations against the company/group

concerns/promoters/management and its impact on company’s performance.

04 Compliance with regulatory prescriptions - Details of any past/ongoing investigations by

statutory/regulatory agencies against the company/group
concerns/promoters/management and its impact on company’s performance.

05 MoA & AoA provides for proposed borrowing

06 Details of project, sell side, buy side agreements entered into by the company, if any

07 Clearances/approvals reqd by the company and current status thereof

08 Land acquisition, if any and status thereof

09 Name, address and contact details of Consultants/LiE/technical collaborators, TEV, etc, if

any, along with ToR and copies of their latest 2 reports.

10 Major raw materials reqd., source, quantity, quality, pricing, FC, firm/long term contracts

11 Requirement of utilities and status therof

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S.N Requirement Check Box
12 Effluent treatment and environment protection

13 Names and creditworthiness of major customers along with payment security mechanism
and availability of long term contracts

14 IFCI exposure to the individual borrower/Group/industry incl. proposed exposure and

compliance with In-house/RBI exposure norms

15 Insurance of assets available and valid up to

16 Current developments, if any

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 Annexure-II
Networth Statement Form
Networth of Mr./Mrs.___________________(as on __________),
Promoter/Director/MD/Gurantor of M/s.____________________

A. Investment in immovable property:

(including construction / investment activity yet to be completed)
S. Details of location Type of If in joint Date of Built-up Cost Market
No. of property Property names with acquisition area (in (Rs. in Value
Including Extent * others sq.ft./sq. lakh) (Rs. in
(As per Revenue & (indicate mt) lakh)
Municipal records, names) @ @
Postal Address)

Total
*Indicate type as Residential/ Industrial / Agricultural / Commercial/ Others (please specify).
@If jointly owned with others, only relevant share to be taken for value.
Note: In case of encumbrance in any of the properties, details of the same should be
given.

B. Investment in Shares / Debentures / Capital / Securities / Bonds /Mutual Funds /

Fixed Deposits (FD), etc.:
S. Name of the Name, Investment Type No. of Cost Market Value
Cost Market Value
No. Company / ID and /(listed/unlisted) units (Rs. in lakh) (Rs. in lakh)
concern / Bank address /Physical form/
of DP, Demat
Bank
Associate / Sister / Group concern

Sub-Total
Others

Sub-Total
Total
Note: In case of encumbrance in any of the investments/FDs, details of the same should
be given.

C. Loan and Advances (Extended):

S. Name of the Company / concern Loan type Tenor of loan Amount
No. (Rs. in lakh)
Associate / Sister / Group concern

Sub-Total
Others

Sub-Total
Total

D. Other Assets(including Gold, Jewellery, Vehicles, etc.):

S. Details Amount Long term / Short
Amount
No. (Rs. in lakh) Term

Total

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 E. Secured / Unsecured Borrowings from:
S. Name of the Nature of Purpose Amount Amount Nature of
No. Lender borrowing Outstanding Overdue, if Security Offered
(Long INVESTMENT (Rs. in lakh) any,
GLOBAL WEST term / PURPOSES (Rs. in lakh)
--------
INVESTMENT BANK
Short
term)
Banks/Financial Institutions/Finance Companies
GLOBAL WEST
1 INVESTMENT BANK
2 GREEN DOT BANK
Sub-Total
Associate/Sister/Group Companies

Sub-Total
Others

Sub-Total
Total

F. Any other liability including outstanding Guarantee Obligation (Institution/Bank-

wise):
S. Details Amount Long term / Short
No. (Rs. in lakh) Term

Total

G. Networth (A+B+C+D-E-F): Rs.__________lakh

I,_________________________________certify that this statement are true and correct to
the best of my knowledge and beleif. son of Mr. _______________, certify that the contents of
I, _______________________________,
this statement are true and correct to the best of my knowledge and belief.

Signature
Signature
Place:
Seal of CA Firm
Place:
Date:
Date:

II. Undertaking/Declaration for Third Party Verification

The borrower, its promoters and key management personnel agree that they do not have any
objection to IFCI or its affiliates seeking third party information about theAuthorised
credit history and
Signatory
records from parties such as CIBIL, RBI, existing lenders including working capital lenders
Lisa Maynard
Authorised Signatory

Place:
Date: