EDC LIMITED
(GOVT. OF GOA FINANCIAL & INVESTMENT CORPORATION)
Corporate Office: 'EDC House', Dr. A. B. Road, Panaji, Goa 403001
Tel.: (0832) 2224541-44,2227604-07 Fax: (0832) 2224938
E-mail: spbhat [at] edc-goa [dot] com Website: www.edc-goa.com
APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER CHIEF MINISTER'S ROZGAR YOJANA
(TO BE SUBMITTED IN DUPLICATE)
1. Name of the applicant
(in block letters):
2. Sex (Male/Female):
3. Father's name/Spouse's name:
Occupation:
Address:
4. Address- (Self)
a) Permanent:
b) Correspondence:
c) Whether residing continuously for the last
three years in the area from where loan is
applied:
Tel No:
Yes/No
5. Age particulars:
a) Date of Birth:
b) Age as on date of application:
6. Qualification:
a) Academic
b) Technical
7. Training received, if any:
(Give name of the institute and duration)
8. Whether the applicant is unemployed?
If so, whether registered with the Employment
Exchange:
(Give Registration No. & Date):
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9. Whether the applicant belongs to SC/ST/BC:
Ex-serviceman/HandicappedlWoman/etc.
10. Type of industry/service/business activity proposed
to be started:
(Give project details in the attached proforma):
'.
11. Previous experience in the line, if any:
12. Place of work where the activity as mentioned
in Col. 10 above is proposed to be started
(give full details):
13. Present annual income of the family duly
supported by the affidavit:
14. Project cost:
a) Machinery & equipment Rs. _
b) Other fixed assets: Rs. _
c) Working capital: Rs. _
Total: Rs. _
15. Amount of Loan required: Rs. _
16. Margin money proposed to be invested: Rs. _
17. a) Whether taken loan from any banking/
financial institution of State/Central Govt.:
b) If yes, for 17 (a) whether all repayments made:
c) If no, for 17 (b) indicate the balance amount:
d) Bank account details:
I certify that all information furnished by me is true and that I have no borrowing
arrangements for my above proposed industrial/service/business concern with any bank!
financial institution.
Signature of the applicant
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PROJECT REPORT FOR FINANCIAL ASSISTANCE
FOR CHIEF MINISTER'S ROZGAR YOJANA
(TO BE SUBMITTED IN DUPLICATE)
I. INTRODUCTION:
II. GENERAL INFORMATION:
i. Name and address of the Unit
ii. Location of the Unit
iii. Item of manufacture
iv. Scope & demand
III. FIXED INVESTMENT:
a) Land & building
i) Covered area ................. sq.meters
ii) On rent
Total:
b) Machinery and Equipment
Name of machinery Qty.
1.
2.
3.
4.
Total
c) Electrification & Office equipment
n Electrification
ii) Office equipment
Total
IV. TOTAL FIXED INVESTMENT
a. Land & Building
b. Machinery & Equipment
c. Elect. & Office Equipment
Total
V. WORKING CAPITALJMONTH:
a) Raw material
1)
2)
., 3) 4)
Total
Rs .
Rs .
Rs .
Rs .
Rs .
Rs .
Rs .
Rs. ,
Rs .
Rs .
Rs.
Rs .
Rs : .
Rs .
Rs.
Rs.
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b) Salaries/wages
Personnel: No.
Rs .
Salary Total Rs.
c) Other expensesper month:
i. Power
ii. Fuel
iii. Water
iv. Rent
v. Postage
vi. Stationery
vii.
viii.
Rs .
Rs .
Rs .
Rs .
Rs .
Rs .
Rs .
Rs...- .
Total Rs.
VI. TOTAL WORKING CAPITAUMONTH
(Va+Vb.+Vc) = Rs .
Working capital
(3 months) Rs .
VII. TOTAL CAPITAL INVESTMENT
a) Machinery and equipment (fixed capital)
b) Working capital
VIII. COST OF PRODUCTION PER ANNUM
i. Total expenditure (w.e.)
ii. Depreciation on building (5%)
iii. Depreciation on machinery (10%)
iv. Interest on loan @ 12.5%
Total
IX. TURNOVER PER YEAR
X. NET PROFIT PER YEAR
XI. PERCENTAGE OF PROFIT ON SALES
XIII. REPAYMENT SCHEDULE PER MONTH
Date: .
Rs.
Rs .
Rs .
Rs .
Rs .
Rs .
Rs .
Rs.
Rs .
Rs .
Rs .
...---- ..
Signature .
(Name in block letters) : _
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