Annexure - B

GOLD CARD SCHEME FOR EXPORTERS
APPLICATION FORM FOR WORKING CAPITAL CREDIT FACILITIES

__________________________________________________
1.1
Name of the Unit (In block letters)
1.2
Constitution
Please strike out which are not applicable
Proprietary/Partnership Firm/Private Limited/ Public Limited Company/Co-operative Society
1.3
Name of the business house/group (of any )
2.1
2.2
Registration No.
(as given by the District Industries Centre/Directorate of Industries)
IEC No.
2.3
Date of Incorporation/ Commencement of Business
3.
Business Address with Telephone/Telex No.
3.1
Registered Office
3.2
Administrative Office
3.3
3.4
Factory
Email address / Website
4.
Background of the Proprietor/Partners/Directors
(Please furnish for each person as per the Annexure I)
5.
Brief Description of the Industrial Activity
5.1
Existing
5.2
Proposed
6.
How the Activity was financed so far (to be filled up in case of existing unit only)
Source of Funds
(*)
Security
Rate of Intt.
Repayment per Month in case of Term Loans only
Present O/S (in 000s of Rs.) Amount of OD (if any)
(*) Indicate sources of funds with name & address, e.g. banks/financial Institutions/others (specify)
7.
Past Performance(To be filled up by existing unit only)(Indicate in 000s of Rs.)
Particulars
Last Year
Last but One Year
Last but Two Years
Turnover Net Profit
Retained Profit
Major Countries to which exports made Monthly Turnover for last twelve months
8.
Arrears in Statutory Payments ( if any)
9.
Whether Merchant Exporter or Manufacturer Exporter
10.
Name of the associate concern(s), if any, and
10.1
Nature of association and amount invested
10.2
Nature of activity
10.3
Items traded manufactured
10.4
Turnover and profit during preceding three years
11.
Technical Feasibility - required only in case of a new unit (As per Annexure IV)
12.
ECONOMIC FEASIBILITY Marketing (mention separately for each product)
12.1
Countries where the product is/will be sold
12.2
How does the unit meets/proposes to meet the competition (comment on the competitive advantages enjoyed by the unit)
12.3
Is the unit selling direct to its customers. If so, please furnish details like sales force, showrooms, depots, warehouses, offices abroad.
12.4
Nature and volume of orders/ enquiries on hand
(certified xerox copies to be furnished)
13.
Future Projections (To be given for the next three years)
Please furnish data on
13.1
Projected balance sheet as per Annexure III
13.2
Working Capital Requirement as per CMA Data
14.
Financial Assistance Required
14.1
Rupee Loan
14.2
Foreign Currency Loan
14.3.
Non-Fund Based Limits, i.e. other Forms of assistance
(e.g. L/Cs. Bank Guarantees, etc).
15.
Details of Securities to be Offered :
15.1
Primary
15.2
Collateral (full details), if any Names & addresses), if any
15.3
Details of guarantor(s) Names & addresses), if any
16
Please indicate whether the proprietor/any of the partners/promoters/
directors have at any time declared themselves as insolvent. If so, details thereof.
17.
Whether the Proprietor/ Partner/Directors/Guarantors are related to any official
of the Bank. If yes, then details thereof.
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 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 deem fit; and you, your representatives, representatives of the Reserve Bank of India/national Bank of Agriculture & Rural Development/Small Development Bank of India/Deposit Insurance & Credit Guarantee Corporation / ECGC / EXIM Bank / CIBIL or any other agency as authorised by you, may, at any time, inspect/verify my/our assets, books of accounts. etc, in our factory/business premises as given above.
Date:
Place: _______________________
Signature of the Borrower
(Name & Designation)
Encl: Certified Xerox copies of
a) Audited Balance sheets with Trade and Profit & Loss Account, for the last three years, and next three years with CMA data,
b) Memorandum and Articles of Association, Certificate for Commencement of Business
c) Income Tax, Wealth Tax Returns and assessment orders for the last three years, for the unit as well as proprietor/partners/promoters/directors
d) Sales Tax Returns for the last three years.
e) Pollution Clearance Certificate
BIO-DATA FORM
(Please use separate sheet for each person)
Annexure - I
1. Full Name (Mr/Mrs)
2. Name of the Father/Husband
3. Passport/PAN No.& Issuing Office
4. Address:
Office Tel No.
Residence
5. Experience
Years Employer Designation
6. Functional responsibilities
in the unit
7. Details of associate concerns
7.1. Name and address of the branch/associates/identical concern
7.2 Activity of the concern
7.3 Functional responsibility in that concern
7.4 Name of the associate concern’s Banker and their address
7.5 Aggregate credit facilities enjoyed by the concern
8. Personal Assets and Liabilities:
8.1 Immovable property
8.2 Other Assets
8.3 Personal Liabilities, if any.
(including guarantees/acceptances given)
9. Any other relevant information
Place:
Date: Signature
GOLD CARD SCHEME FOR EXPORTERS
Annexure II
Details of Existing Fixed Assets
A. Land & Building
1. Location
2. Area
3. Whether Freehold or Leasehold
4. Purchase Price of Land if owned
5. rent in case of Leased land
6. Terms of Lease
Particulars of Machinery
Serial No.
Name of Machinery and specification
Second Hand/New
Imported/
Indigenous
Invoice Price including taxes for Indigenous Machinery CIF for Importers Machinery
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1. Existing Machinery
1.1 Indigenous
1.2 Imported
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Annexure III
Projected Balance Sheet
(Figures in 000s of Rs.)
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1st 2nd 3rd
year year year
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Liabilities
1. Equity Share Capital
2. Reserve and Surplus
3. Term Loans
4. Bank Borrowings for Working Capital
5. Other Liabilities
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Total Liabilities
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Assets
1. Gross Block
2. Depreciation
3. Net Block
4. Investment
5. Current Assets
6. Cash and Bank Balances
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Total Assets
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Annexure IV
Technical Feasibility (To be submitted only in case of new connection)
1
Name of the Product(s),
including bye-products &
its (their) use and its
manufacturing process in brief
1.2 Capacity : (No. of Units/Quantity in kg/
Volume in Litre per annum)
Capacity for
each product
Licensed
Installed
Operating
No. of working days in a month&
No.of shifts in a day
1.3
1.4
Locational advantages of existing
and/or proposed premises
with reference to availability of
raw material, power,
skilled labour, transport etc.
Whether clearance has been obtained
from the pollution control authority
1.5
PARTICULARS OF MACHINERY & OTHER FIXED ASSETS
As per Annexure II
1.6
RAW MATERIALS/COMPONENTS
(Please mention about the requirement & availability of imported and indigenous items separately)
2.
UTILITIES
(Give comments on requirement, availability/adequacy, qualitative aspects, etc).
2.1
Power arrangements
including standby
2.2
Water (Enclose certified xerox copy of sanction for water connection)
2.3
Fuel
2.4
Others (specify)
3.
QUALITY CONTROL
3.1
Details of arrangement made for
quality control like ISI/ISO/OHSAS etc