Application From for Financing Small Scale Industries
-Total assistance including working capital not exceeding Rs.25,000/-

The Branch Manager,
_________________Branch
Dear Sir,
I/We hereby apply for advance facilities and furnish the following information therefore:
Name of the unit
Business Address :
Registration No.
Proprietor/Partner
Name(s) and Age Address Past Experience
____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________
Belongs to Scheduled Caste/Tribe Technically Qualified/Experienced Educated Unemployed
Yes No
Yes No
Yes No.
Whether belongs to Minority Community Yes No
If yes, tick the appropriate box.
Muslims Sikhs Christians Neo-Buddhists Parsi/Zoroastrians

Land Holding
Name of Applicant/Family Member Size and Particulars of Land Holding
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________

Size of Applicants’ Family

Adults

Children

Total Present Income of the Family
Rs.

Min. Sustenance required for family maintenance per month
Rs. Sources of Income
Brief Description of Existing/Proposed Line of Industrial/Business Activity

No. of Persons Employed No. of Persons Proposed to be Employed

Existing Finance : Own Funds Rs.
Source of Borrowings Security Borrowings Rs.
Repayment Rate of Int.
____________________________ _________________ __________________ __________________
____________________________ _________________ __________________ __________________
____________________________ _________________ __________________ __________________
____________________________ _________________ __________________ __________________
____________________________ _________________ __________________ __________________
Purpose of the New Loan

Amount of Loan Required Rs.

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; that no legal action has been/is being taken against me/us, 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 that you, your representatives, representatives of the Reserve Bank of India or any other agency as authorized by you, may, at any time, inspect/verify our assets, books of accounts, etc. in our factory and business premises.

Yours Faithfully,

Signature of the Applicant

Date :

Place :