Application Form for Cent Sahyog (For Loans up to Rs.10 lacs)
1 Name of Unit
Name/s of Proprietor / Partners
PAN No./s of Proprietor / Partners /Partnership Firm
Category of Unit Micro/Small
Manufacturing / Service
Constitution Proprietorship/ Partnership
Business Address
City Pin- Code:
State
Telephone Nos.
Name & Address of bankers to the company &
details of credit facility, if any
2 Personal Details of Key Person/ Sole Applicant
Name of the key promoter
Date of Birth
Qualification (mention if Professional)
Mailing Address
Pin Code :
Telephone Nos.
PAN No. of the Applicant
3. Business / Line of Activity
4. Project Details
Item Cost of Funds (Rs. in Lacs)
Item Sources of Funds(Rs.
in Lacs)
Land & Improvements Applicant’s
Investment
Building & Structures Bank Loan
Machinery & Equipment Loans from Friends &
Relatives
Other Capital
Cost(Specify)
Others
Working Capital
Total Total
5. Assets (Rs. in Lacs) Liabilities (Rs. in Lacs)
Total Total
6. Miscellaneous Details
Amount of Loan Required
Repayment Period for Term Loan
Marketing Arrangement
I declare that the information furnished is true & correct.
Yours faithfully,
(Authorised signatory)
Please attach :
Brief detail of the Project
Declaration of Income.
For existing Units – Balance Sheets for the past 2 years along with estimated & projected Balance
Sheets ( where ever available)
Copy of SSI Registration Certificate / Application for New Units
Photographs – 2
Proof of Address & Photo Identity for KYC compliance
Pan Card
Pollution Control Certificate, wherever applicable