INDIAN OVERSEAS BANK
SMALL AND MEDIUM ENTERPRISES
APPLICATION FORM FOR CREDIT FACILITIES UPTO Rs.10 lacs
SME-5

1.1. Name of the Unit (In Block letters)
1.2. Constitution PROPRIETARY / PARTNERSHIP FIRM / PVT. LTD.,
PUBLIC LTD. CO. / CO-OPPERATIVE SOCIETY
1. Name of the business house / group (if any)
2. Registration No. (as given by District Industries
Centre / Directorate of Industries)
3. Business Address with Telephone / Cell / Fax No. /Email address
Residence address With Telephone /Cell / Fax No.
4. Category of Enterprise MICRO ENTRERPRISES / SMALL ENT. /
MEDIUM ENTERPRISES
5. Nature of Enterprise Mfg. Enterprises / Service Enterpirses
6. Background (To be filled up for each individual)
6.1 Proprietor / Partners / Directors
NAME FATHER’s / HUSBAND’s NAME AGE SEX
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6.2. Whether the applicant belongs to SC / ST / Yes / No
Minority Community
If yes, please furnish proof thereof
6.3. Whether the applicant belongs to Ex-Serviceman. Yes / No
If yes, please furnish the proof thereof
6.4. Present annual income of the family, with brief details of the sources
(indicate farm income & non farm income separately)
7. Size of the applicant’s family Adult …… Children …..
8. Please furnish ration Card No. & Name of the issuing office
9. Size and particulars of land holdings, if any, in the name of the
applicant / family members.
10. Minimum amount required per month for
family maintenance
11. Cost of the project
Fixed Assets Rs. . . . . . . . .
Current Assets Rs. . . . . . . . .
TOTAL Rs.
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12. Brief description of the industrial activity
12.1 Existing
12.2 Proposed
13.1 Number of persons presently employed
(to be filled up in case of existing unit only)
13.2 No. of persons proposed to be employed
14. How the activity was finance so far
Source of
funds
Security Rate of
interest
Repayment
per month
Present
o/s.
Amount of
default, if
any
Indicate name and address of the sources of funds, eg. Banks, Financial
Institutions / others (specify)
15. Raw materials required (quantity) and sources of supply
16. Location of the market for the product(s)
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17. Financial projections
PARTICULARS 1st year 2nd year 3rd year
Turnover
Raw materials
purchase
Other expenses
Profit
(Indicate the assumptions based on which the above figures have been
worked out)
18. Purpose of the new loan
19. Amount of the loan required
20. Wish to authorize the bank to forward the application
to the GSTMSE for coverage under their
Credit Guarantee Scheme YES / NO
21. Means of Financing
21.1 Promoter’s contribution
21.2 Subsidy, if any
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21. 3 Seed Capital
21.3 Loan – Term Loan
Working capital
I / We certify that all information furnished by me/us is true that I / We
have no borrowing arrangements for the unit with any bank except as
indicated in the application that there is no overdues / statutory dues
against me / us / promoters that no legal action has been / is being taken
against me / us / promoters that I / We shall furnish all other information
that may be required by you in connection with my / our application, that
this may also be exchanged by you with any agency you may deem fit,
and you, your representatives, representatives of the Reserve Bank of
India / National Bank for Agriculture & Rural Development / Small
Industries Development Bank of India / Credit Guarantee Fund Trust for
Micro and Small Enterprises or any other agency as authorized by you,
may at any time inspect / verify my/our assets, books of accounts in our
factory business premises as given above.
I / We agree and give my / our consent to you for disclosure of any / all
data information / dues / defaults relating to my / our account to Credit
information Bureau (India) or any other similar agency so authorized by
RBI. These agencies may furnish for consideration the processed
information and data or products there of prepared by them to Banks /
financial institutions and other credit granters or registered users as may
be specified by the Reserve Bank.
Date:
Place: Signature of the Applicant
(Name & Designation)