Application Form For MSEs

Name of the Branch : _____________________________
T o be submitted along with documents as per the checklist
( for Office Use)
1. Name of the Enterprise
2. REGD OFFICE ADDRESS
3. ADDRESS OF FACTORY / SHOP
4.WHETHER BELONGS TO SC/ST/OBC/MINORITY COMMUNITY
Telephone No E-mail address
Mobile No PAN CARD NO
5.CONSTITUTION Proprietary / Partnership Firm / Pvt Ltd / Ltd Company / Co-op Society
6.Date of Establishment
7. Name of Proprietor / Partners / Directors of the Company and their address
NAME AGE ACADEMIC
QUALIFICATION
ON
RESIDENTIAL
ADDRESS
PHONE
NO (RES)
Experience IN THE LINE OF ACTIVITY
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8. ACTIVITY EXISTING PROPOSED
9. NAME OF ASSOCIATE CONCERNS AND NATURE OF ASSOCIATION
NAME ADDRESS PRESENT
BANKER NATURE OF ASSOCIATION EXTENT OF INTEREST AS A PROP / PARTNER / DIRECTOR OR JUST INVESTOR IN ASSOCIATE CONCERN
10. Relationship of proprietor / Partner / Director with
the officials of the Bank / Director of the Bank
10 (a) CREDIT FACILITIES (EXISTING) ( Rs in lakhs)
Type of facility
Limit Balance Present
Banker
Security
Lodged
Rate of interest
Repayment
Current A/c
Cash Credit
Term Loan
LC / BG
If banking with our bank, CIF and Account Nos
10 (b) It is certified that our unit has not availed any loan from any other Bank / Financial
Institution in the past and I am not indebted to any other Bank / Financial Institution other than those mentioned above
11. CREDIT FACILITIES PROPOSED
Type of facilities
Amount Purpose for which required
Security Offered
Primary Security (Details with
approx value to be mentioned)
Whether collateral security offered
(Please mention yes or no) (if Yes, then provide detailed below)
Cash Credit
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Term Loan
LC / BG
In case of Term Loan requirements , the details of machinery may be given as under
Type of Machine
Purpose for which required
Whether imported or indigenous
Name of supplier
Total cost of machine
(in case of imported machine, the breakup of basic cost, fright, insurance and customs duty may be given)
Contribution being made by the promoters
Loan required
12. Details of collateral security offered, If any, 3rd party guarantee *
(* as per RBI guidelines bank are not to take collateral security for loans upto Rs 5 lakhs to MSME
units )
13. PAST PERFORMANCE / FUTURE ESTIMATES (Actual performance for two previous years,
estimates for current year and projections for next year to be provided for working capital facilities. However for term loan facilities projections to be provided till the proposed year of repayment of loan)
(Rs. in lacs) Past Year II
Actual
Past Year I
actual
Present Year
(Estimates)
Next Year
(Projections)
Net Sales
Net Profit
Capital (Networth in
case of companies)
14. Status regarding Statutory Obligations
Statutory Obligation Whether Complied with
(Write Yes / No). If not
applicable, then write
N.A.
Remarks (Any Details in
connection with the relevant
obligation to be given)
1. Registration under shops and
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establishment Act
2. Registration under SSI (Prov/final)
3. Drug Licence
4. Latest Sales tax returns filed
5. Latest Income Tax returns filed
6. Any other statutory dues remaining
outstanding
SPACE FOR PHOTO SPACE FOR PHOTO SPACE FOR PHOTO
Only one photo of proprietor / each partner / each working director is required to be affixed.
Each photo will be certified / attested by the Branch Team with name and signatures on the
photograph with Branch stamp. The concerned staff will put his name below the signatures.
Date: Place:
I / We certify that all information furnished by me/ us is true; that I / We have no borrowing
arrangements for the unit except as indicated in the application; that there are no overdues /
statutory dues against me / us / promoters except as indicated in the application; 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 deemed fit and you, your
representatives, representatives of the Reserve Bank of India or any other agency as
authorized by you, at any time, inspect / verify my / our assets, books of accounts etc., in our
factory / business premises as given above.
Signature of promoter(s )/ applicant(s)
Date:
E:\SMEAUG07\forms\mseform.doc
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CHECK LIST (TO BE GIVEN TO THE NEW CUSTOMERS BY BRANCH) OF DATA TO BE KEPT READY BY
THE CUSTOMER
1. Proof of Identity – Voter’s ID Card / Passport / driving license / PAN Card / signature identification from
present bankers of proprietor , partner or Director (if a company)
2. Proof of residence – Recent telephone bills, electricity bill, property tax receipt / passport / voter’s ID card
of proprietor , partner or Director (if a company)
3. Proof of business address
4. Proof of Minority
5. Last three years balance sheets of the units alongwith income tax / sales tax returns etc. (Applicable for
all cases from Rs. 2 lacs and above). However, for cases below fund based limits of Rs. 25 lacs, if
audited balance sheets are not available, then unaudited balance sheets are also acceptable as per
extant instructions of the Bank. For cases of Rs. 25 lacs and above, the audited balance sheets are
necessary.
6. Memorandum and article of association of the Company / Partnership deed of partners etc.
7. Assets and liabilities statements of promoters and guarantors alongwith latest income tax returns
8. Rent agreement (if business premises on rent) and clearance from pollution control board, if applicable.
9. SSI registration if applicable
10. Projected balance sheets for the next two years in case of working capital and for the period of the loan
in case of term loan (for all cases of Rs. 2 lacs and above)
11. In case of take over of advances, sanction letters of facilities being availed from existing bankers /
Financial Institutions alongwith detailed terms and conditions.
12. Profile of the unit (includes names of promoters, other directors of the company, the activity being
undertaken, addresses of all offices and plants, share holding pattern etc) – APPLICABLE FOR CASES
WITH EXPOSURE ABOVE Rs. 25 lacs
13. Last three years balance sheets of the Associate / Group Companies, if any – APPLICABLE FOR
CASES WITH EXPOSURE ABOVE Rs. 25 lacs
14. Project report (for the proposed project if term funding is required) containing details of the machinery to
be acquired, from whom to be acquired, price, names of suppliers, financial details like capacity of
machines, capacity utilization assumed, production, sales, projected profit and loss and balance sheets
for the next 7 to 8 years till the proposed term loan is to be repaid, the details of labour, staff to be hired,
basis of assumption of such financial details etc.) – APPLICABLE FOR CASES WITH EXPOSURE
ABOVE Rs. 25 lacs
15. Review of account containing monthwise sales (quantity and value both), production (quantity and
value), imported raw material (quantity and value), indigenous raw material (quantity and value), value of
stocks in process, finished goods (quantity and value), debtors, creditors, bank’s outstanding for working
capital limits, term loan limits, bills discounted. – APPLICABLE FOR CASES WITH EXPOSURE ABOVE
Rs. 25 lacs
16. Photocopies of lease deeds / title deeds of all the properties being offered as primary and collateral
securities.
17. Position of accounts from the existing bankers and confirmation about asset being standard with them (in
case of take over)
18. Manufacturing process if applicable, major profile of executives of the Company, any tie ups, details
about raw material required and their suppliers, details about buyers, details about major competitors
and company’s strengths and weaknesses as compared to competitors etc. – APPLICABLE FOR
CASES WITH EXPOSURE ABOVE Rs. 25 lacs
(The check list is only indicative and not exhaustive and depending upon the local requirements at different
places, addition could be made as per necessity)