Appendix-III
APPLICATION DETAILS (For use of Member Lending Institutions)
Specimen Application
BANK REFERENCE NUMBER*__________________________ PRIME LENDING RATE*_____________ IN %
SSI DETAILS
NAME OF THE UNIT*___________________________________________________
NAME OF THE CHIEF PROMOTER* ______________________________________
IT PAN OF THE CHIEF PROMOTER* _____________________________________
GENDER* Male Female
ADDRESS OF THE UNIT* _________________________________________________________________
_________________________________________________________________
CITY*_____________________ PIN CODE* _______________________
STATE* ______________________ DISTRICT* ________________________
STATUS* PROPRIETORY PARTNERSHIP PRIVATE LTD
PUBLIC LTD. OTHERS
NAME OF THE OTHER PROMOTERS ____________________________________
SSI REGISTRATION NUMBER ________________________________________
DATE OF INCORPORATION ________________________________ DD/MM/YYYY
UNIT TYPE* NEW EXISTING
IF EXISTING UNIT, FILL THESE DETAILS
OUTSTANDING DEFAULT
AMOUNT _____________________________ in Rs. AMOUNT ______________________________ in Rs.
PROJECT DETAILS-OUTLAY
PROJECT * PROJECT COST (Exculuding WORKING
SCHEME ____CGFSI______________ CAPITAL ASSESSED) _________________________________
WORKING CAPITAL TOTAL
ASSESSED* ___________________________ in Rs. AMOUNT _______________________________
PROMOTERS'S CONTRIBUTION* ______________________________________________ in Rs.
EQUITY TYPE ASISTANCE
NEF AMOUNT* ________________________ in Rs. OTHER* ___________________________ in Rs.
TOTAL _______________________________ in Rs.
COLLATERAL THIRD PARTY
SECURITY TAKEN* YES NO
GUARANTEE TAKEN* YES NO
TYPE OF INDUSTRY* _____________________________________ NO. OF EMPLOYEES* ____________________
PROJECTED PROJECTED
SALES TURNOVER* __________________ in Rs. EXPORTS __________________________ in Rs.
FINANCIAL ASSISTANCE
TYPE OF LOAN FACILITY* Term Credit Working Capital Both
TERM CREDIT DETAILS
AMOUNT AMOUNT
SANCTIONED* _________________________ in Rs. DISBURSED __________________________________ in Rs.
DATE OF INTEREST
SANCTION* _________________________ dd/mm/yyyy RATE* _______________________________________ in %
DISBURSEMENT OUTSTANDING
DATE* _____________________________ dd/mm/yyyy TERM CREDIT* ________________________________ in Rs.
IS THIS THE LAST DISBURSEMENT* Yes No
TENURE OF TERM CREDITh
MORATORIUM* ___________________________________months
REPAYMENT* ____________________________________ months TOTAL ______________________ months
WORKING CAPITAL ASSISTANCE
LIMIT DATE OF
SANCTIONED* ___________________________ in Rs. SANCTION* ________________________________ dd/mm/yyyy
INTEREST OUTSTANDING
RATE* ________________________________ in % AMOUNT __________________________________ in Rs.
APPLY CLEAR
NOTE APPLICATION FOR EACH OF THE BORROWER ACCOUNT IS TO BE SUBMITTED BY THE MEMBER LENDING INSTITUTION ONLINE OR THROUGH THIN CLIENT MODULE.
* Mandatory Fields
