APPLICATION TO BE SUBMITTED BY SHG
TO BANK BRANCH WHILE APPLYING FOR LOAN ASSISTANCE

Name of the Self-Help Group :

Address :

Formed/Established on Registered : Yes / No

If registered: give number and
date and furnish true copy of
the Certificate of Registration.

Number of members in the Group :

Name of SHPI/NGO/VA assisting the Group : if any:

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To: Date :
The Branch Manager,
____________Branch

Dear Sir,

1) APPLICATIN FOR LOAN
We the duly authorized representatives of the above SHG hereby apply for a loan aggregating Rs……..……………. (Rupees……………………………………………………………….only) for on-lending to our Members. The financial particulars of the group as on ___________________ are given herewith:
(Date)

2) REPAYMENT SCHEDULE
We agree to repay the loan amount as per the repayment schedule which may be fixed by the Bank.

3) A copy of the Inter-se Agreement executed by all the members of the group authorizing us, interalia, to borrow on behalf of the SHG is enclosed.

4) We hereby declare that the particulars given above are true and correct to the best of our knowledge and belief.

5) We hereby authorize the Bank to disclose all or any particulars or details or information relating to our loan accounts with the Bank, to any other financial institutions including NABARD, Government or any agency as may be considered necessary or desirable by the Bank. It will be in order for the Bank to disqualify the SHG from receiving any credit facilities from the Bank and/or recall the entire loan amount or any part thereof granted on this application, if any of the information pertaining to the Group, furnished herewith is found incorrect and/or containing misrepresentation of facts.

Yours faithfully,

1. 2.

(Authorised representatives)
Financial particulars as on ______________________________

Sr.No. Particulars Amount
(in Rs.)

1) Savings from Members __________________
2) Seed Money from SHPI (NGO/VA, if any) __________________
3) Borrowings Outstanding
(Please specify source) __________________
4) Loans outstanding against members __________________
5) Amount in default, if any, against members __________________
6) Recovery percentage __________________
7) Cash/bank balance __________________

(Authorised representatives)

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FOR BANK’S USE Branch______________

a. Name of SHG :
b. No. of Members :
c. Activity of the Group :
d. Name of the NGO/VA, if any, and :
its role in promoting the Group.

e. Savings of the Group as of date :
f. Past Performance of the SHG :
with regards to savings and
Credit operations from its own
resources as internal loaning

g. Performance of the SHG with :
regard to credit facility already
availed, if any.

h. Other relevant information, if any :

Recommendations Sanctioned

RDO/ACCOUNTANT BRANCH MANANGER