Application Form for Micro, Small and Medium Enterprises
For Credit Facilities over Rs. 50 Lakh & Upto Rs.2 Crore
1.1 Name of the Unit
( In block letters)
1.2 Constitution √ Proprietary Partnership Pvt. Ltd. Ltd. Company Co-op.society Any Others
(Specify)
1.3
Name of the Business
house/ group (if any)
2.1
Registration No.
( Given by District Industries
Centre / Directorate of Industries)
2.2 Date on Incorporation / Commencement of Business
3. Business Address with Telephone No.
3.1
Registered Office
3.2
Administrative
Office
3.3
Factory Address
Telephone Nos. Mobile No.
PAN No. E-mail ID
4. Background of the Proprietor / Partners / Promoters/ Directors
(Please furnish information for each person as per the Annexure - I)
5. Brief Description of the Industrial Activity
5.1 Existing
5.2 Proposed
PNB-1016 (Revised/2011)
2
6. How the Activity was financed so far: (to be filled up in case of existing unit only)
Source of Funds (*)
Security
Rate of Int.
Repayment
per month
Present O/s
(in 000s of Rs.)
Amount of
Default
(if any)
(*) (Indicate sources of funds with name & address, e.g., banks/ financial institutions/others (specify))
7. Past Performance: (To be filed up in case of existing unit only)
(indicate in 000s of Rs.)
Particulars Last Year Last but one Years Last but Two years
Turnover
Net Profit
Retained Profit
Monthly Turnover of last twelve months
8. Arrears in Statutory Payments (if any)
a) Income Tax
b) VAT Tax
c) Provident Fund
d) Employees State
Insurance Corporation
e) Others (specify)
9.
If the Unit is an ancillary unit, the
undertaking to which it is catering and its
address
3
10. Name of the associate concern(s), if any and
10.1 Name 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. Employment
Present Proposed
Executives
Supervisory
Administrative/ Office Staff
Skilled Labour
Unskilled Labour
12. TECHNICAL FEASIBILITY
12.1 Name of the Product(s), including bye-products & its (their) use:
12.2 Manufacturing Process, in brief. (Indicate to the extent possible, stage-wise capacity data,
yield /conversion data, material flow, etc.)
12.3 Capacity (No. of Units Quantity in Kg./ Volume in litre per anum)
Capacity for each product Licensed Installed Operating
No. of working days in a month __________________________
No. of shifts in a day __________________________________
4
12.4. Locational advantages of existing and/or proposed premises with reference to
i) Absence of civic restrictions.
_________________________________________________________________________
ii) Proximity to the source of raw materials,
_________________________________________________________________________
iii) Market for the product,
_________________________________________________________________________
iv) Availability of
a) Power
___________________________________________
b) Water
___________________________________________
c) Labor
___________________________________________
d) Transport
___________________________________________
v) whether clearance has been obtained from the
pollution control authority:
12.5 LAND & BUILDING
Area/Plinth Area (in sq. meters) Value (in 000s of Rs.)
Existing Proposed Existing Proposed
Factory Land
Factory Building
Ancillary Building
Open Storage Space
12 .6 Type of soil and load bearing capacity (enclose test report)
_______________________________________________________________________________
Enclose: a) certified xerox copy of sale / lease deed
b) certified xerox copy of the Govt. order converting the land into industrial land, if
applicable
c) location map
d) certified xerox copy of the site plan of the land and blueprints of the buildings duly approved by
corporation / municipality / panchayat.
12.7 PARTICULARS OF MACHINERY AND OTHER FIXED ASSETS
As per Annexure II
5
__________________________________________________________________________
12.8 Necessity & purpose for the proposed investment / addition
to factory premises/machinery (in case where such investment
is intended) for achievement of the anticipated turnover.
__________________________________________________________________________
12.9. RAW MATERIALS / COMPONENTS
(Please mention about the imported and indigenous items separately)
Name/ Brief Description of the items
(A) (B) (C) (D)
Quantity Required
Sources of supply
Minimum Purchase Quantity
Lead/ Procurement Time
Available throughout the year
If answer to the above is no,
then no. of months & period
when it is available
(enclose copies proforma invoice in respect of each item, if available)
13. UTILITIES
(Give comments on requirement. availability/adequacy, qualitative aspects, etc.)
13.1 Power :
Contracted Load
________________________________________________________
Connected Load
________________________________________________________
Future power consumption
(in no. of units ) per month
________________________________________________________
Stand-by Arrangements
________________________________________________________
( Enclose certified Xerox copy of sanction for power connection )
13.2 Water
(Enclose certified Xerox copy of sanction for water connection)
___________________________________________________________________________
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13.3 Fuel
___________________________________________________________________________
13.4 Others (specify)
___________________________________________________________________________
14. QUALITY CONTOL
14.1 Details of arrangements made for quality control. (If BIS/FPO/ISO specifications are followed, no. of
BIS/FPO/ISO Standards and the particulars thereof should be provided.
____________________________________________________________________________
14.2 Particulars of R&D activity proposed
____________________________________________________________________________
15 ECONOMIC FEASIBILITY (Marketing (mention separately for each product.)
15.1 Whether the product is reserved exclusively for SSI sector:
____________________________________________________________________________
15.2 Name of Major customers:
____________________________________________________________________________
15.3 Region /Area where the product is/will be sold:
____________________________________________________________________________
15.4 Extent of competition & No. of Units engaged in similar line in the area:
____________________________________________________________________________
15.5 How does the units meet/proposes to meet the competition
(comment on the competitive advantages enjoyed by the unit)
____________________________________________________________________________
7
15.5.1 In price, and quality, how does the unit’s Product compare with those of its competitors
____________________________________________________________________________
15.5.2 Is the unit selling direct to its customers? If so, please furnish details like sales force,
showrooms, depots etc.
15.5.3 If a selling/distribution agency had been appointed, its name, Period of contract, omission
payable, period by which the bill will be paid by it etc
(Enclose copies of agreement, wherever such agreement has been entered into)
____________________________________________________________________________
15.6 Nature and volume of orders/ enquiries on hand ( certified Xerox copies to be furnished )
____________________________________________________________________________
15.7 If the Unit is export oriented, please furnish exporter code no. , if allotted, and relevant details
as per the following details in the preceding three years:-
Code No._________________
Name of the Product Exported Name of the Country where Exported F.O.B. value in US $
8
16 Cost of Project
(Please furnish estimates of cost of project under the following heads.
Indicate the basis for arriving at the cost of project)
(In 000s of Rs.)
Sr. No Particulars Already
incurred
To be
incurred
Total cost
A Land including development
BuilBd ing Building & other Civil Works
C Plant & Machinery
1) Indigenous
2) Imported
D Essential Tools, Spares and
Accessories
E Testing Equipment
F Miscellaneous Fixed Assets
G Erection/Installation Charges
H Preliminary Expenses
I Pre-operative Expenses
J Provision for Contingencies
1)Buildings
2)Plant & Machinery
3)Other Fixed Assets
K Margin for Working Capital
Required
L
Total
9
17 Means of Financing
(Please furnish details of sources of finance for meeting the cost under the following heads)
(in 000s of Rs.)
Sr. no. Particulars Amount Already
Raised
Amount Proposed
to be Raised
Total
A Capital
(specify resources contributing
capital)
B Reserves
C Term Loans
(give full particulars)
D Unsecured Loans, and deposits
(indicate sources, rate of
interest, repayment period etc.)
E Deferred Payment Arrangements
Including Supplier’s Credit
F Subsidy
Central Govt.
State Govt.
G Seed capital
(indicate sources)
H Internal cash Accurals
I Other Sources (specify)
J Total
17.1 In case internal accruals are taken as source of finance explain the basis for estimation of
internal accruals by means of statement.
17.2 Indicate sources from which expenditure already incurred has been financed
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17.3 Promoter’s contribution to the project as % of the total cost
(Please furnish list of persons/firms who would be contributing to the promoters share of the
capital and the respective amounts and their relationships)
_____________________________________________________________________________
18. Schedule of Implementation:
Please indicate the progress made so far in the implementation of the project and furnish the
Schedule of implementation as follows:
Date of
commencement Date of completion
a) Acquisition of Land
b) Development of Land
c) Civil works for
Factory Building
Machinery Foundation
Administrative Building
d) Plant & Machinery
Imported
Indigenous
e) Arrangement for power
f) Arrangement for water
g) Erection of equipment
h) Commissioning
i) Initial Procurement of Raw Material
j) Trial Runs
k) Commercial Production
19 Future Projections
(To be given for the next three years)
Please furnish data on
19.1 Projected profitability as per Annexure III
19.2 Projected cash flow statement as per Annexure IV
19.3 Projected Balance Sheet as per Annexure V
19.4 Working Capital Requirement Annexure VI
11
19.5 Percentage of Cash Sales in Total Sales ______%
Period in which payment is received in respect of credit sales _________days
Average credit available on purchases ________days
__________________________________________________________________________
20 Financial Assistance Required:
20.1
Rupee Loan
20.2
Foreign Currency Loan
20.3
Term Loan
20.4
Working Capital
(as worked out in Annexure VI)
20.5 Non-Fund Based Limits, i.e., Other Forms
of assistance
(E.g. L/Cs, Bank Guarantees, etc.)
21. Repayment Programme:
__________________________________________________________________________
22 Details of Securities to be offered:
22.1 Primary (Working capital and term loan securities to be indicated separately)
___________________________________________________________________________
22.2 Collateral, if any (full details)
___________________________________________________________________________
22.3 Details of guarantor(s) (Use separate sheets, if required)
22.3.1 Name
22.3.2 Residential Address
22.3.3 Telephone/Mobile No.
22.3.4 Email ID
22.3.5 PAN No.
22.3.6 Occupation
(If in service, name & address of his/her employer)
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22.3.7 Details of Movable & Immovable Property (ies) Owned by him/her & other dependent family
members
__________________________________________________________________________
22.3.8 Details of any similar guarantee, if any, given to other institutions
____________________________________________________________________________
23. Whether any Government enquiry, proceedings or prosecution has been instituted against the
unit or its proprietor/partners/directors for any offence ? If so, please give details.
____________________________________________________________________________
24. Details of pending litigation, if any, against and by the unit.
____________________________________________________________________________
25. Please indicate whether the proprietor/any of the partners/ promoters/ directors have at any
time declared themselves as insolvent. If so, give details thereof.
____________________________________________________________________________
I/We certify that all information furnished by me/us it 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/promoter except as indiacted in the application ; that no legal
action has been / is being taken against me/us/promoter ; 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 ; any you, your representatives, representatives of the
Reserve Bank of India/ National Bank of Agricultural & Rural Development /Small Industries
Development Bank of India /Deposit Insurance & Credit Guarantee Corporation or any other agency as
authorized 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 and Designation)
Encl: Certified Xerox Copies of
a) Audited Balance Sheets with Trading And Profit & Loss account, for the last three years.
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.
13
Annexure -1
BIO-DATA FORM
Details of Proprietor/Partners/Managing Partner/Promoters/Directors/Managing Director
(Please indicate inter-relationship, if any, among the partners/directors/promoters)
(Please use separate sheet for each person)
1 Full Name
2 Name of the
Father/Husband
3 Age
4 Sex
M
F
5 Whether belongs to SC /
ST / Minority Community.
Yes No
6 Are You an Ex-service
man
Yes No
7 PAN No. E-mail ID
7(a) Ration Card No.
and Name of the
Issuing Office
Passport
No.
8 Telephone No. Mobile No.
9 Address Office:
10 Permanent
Residence
Academic
Qualification
11 Experience:
Years
Employer
Designation
Last Salary Drawn
12
Functional
Responsibilities in the unit
13.
Capital/Loan Contribution
in the unit
At the Beginning At present
14
14 Reasons for joining/
establishing the unit
(Please mention about the
motivating factors )
15. If associated as proprietor/partner/director/ shareholder with concerns other than the applicant
unit, please furnish following details separately for each concern by way of enclosure
15.1
Name and address of the
branch/associates/identical
concern
15.2
Activity of the concern
15.3
Functional responsibility in
that concern
15.4
Capital/Loan Contribution
15.5
Name of the associate
concern’s
Banker and their address
15.6 Aggregate credit facilities
enjoyed by the concern
15.7
Security offered by the
concern for its borrowing
15.8
Working results of the unit
for the past three years
16. Personal Assets and Liabilities :
16.1 Immovable property details like land/buildings, Location, date of acquisition, cost, present value
etc.
____________________________________________________________________________
16.2 Other Assets
____________________________________________________________________________
16.3 Personal Liabilities, if any. (including guarantees/acceptances given)
____________________________________________________________________________
17. Any other relevant information
____________________________________________________________________________
Place:
Date:
Signature
15
Annexure-II
Details of Existing Fixed Assets
A. Land
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
7 Ground Rent payable per year
B. Building
1 Location
2 Whether Owned or Leased
3 Purchase price of Building if owned
4 Rent in case of Leased/Rented Premises
5 Terms of Lease
Structure Type of Structure
(indicate “P” if
Permanent)
Dimensions Area
(in Sq. m.)
Actual Cost
(in Rs.)
Date of
Erection
1) Workshop
2) Godown
3) Administrative
4) Other
Buildings
In case the assets have been revalued or written up at any time during the existence of unit, furnish
Full details of such revaluation together with the reason therefore.
16
Particulars of Buildings Proposed to be Constructed
Serial
No.
Description of
Each Building
Type
of
Construction
Built-up Area (in meters)
Total
Floor in
Sq. m.
Rate of
Construction
per
Sq. m.
Estimated
Cost of
each
Building
Expected
Date of
Completion
Length Breadth Average
Height
Note : 1. In case contract is awarded for construction of building, furnish details thereof such as
name of Contractor, amount of contract, etc.
2. Other approvals from inspector of factories, drug Controllers, etc., if any, should be enclosed
3. Please enclose a plan showing layout of machinery.
Particulars of Machinery
S.
No.
Name of Machinery
and Specification
Second
Hand/
New
Name of
Manufacturer/
Fabricator
(place of
County and
Origin, if
Imported)
Date of
Acquisition/
Date of
Placement
of order
(actual/
expected)
Expected
Date of
Delivery
Invoice
price
including
Taxes for
Indigenous
Machinery/
CIF
For
Imported
Machinery
Estimated
expenses o/a
Of insurance
freight
Installation,
Import
Duty
Total
Cost
1 Existing
Machinery
1.1Indigenous
1.2Imported
2 Proposed to be
acquired
2.1Indigenous
2.2Imported
1. Quotation / Catalogues / Invoice and other details in respect of each machine to be furnished.
2. If second had machinery, valuation report regarding age, performance and value from competent valuer
to be submitted. Also please indicate reasons for going in for second hand machinery and its
depreciated value.
3. In case of imported machinery, please indicate mode of payment and price of the machinery in foreign
currency.
4. In case the assets have been revalued or written up at any time during the existence of unit, furnish full
details of such revaluation together with the reason therefor.
17
Annexure-III
Projections of Performance , Profitability and Repayment
Break-even point Break-even Quantity
% of installed capacity Break-even Value
[Amount in Lakh]
1st
year
2nd
year
3rd
year
4th
year
5th
year
A.
Production during the year(Quantity)
% utilization of installed capacity
B.
Sales
1 Sales including all miscellaneous receipts
2 Less Excise
3 Net Sales
C.
Cost of Production
1
Raw Material Consumed
2
Power and Fuel
3
Direct Labour and Wages
4
Consumable Stores
5
Repairs and maintenance
6
Other Manufacturing Expenses
7 Deprecation/Development Rebate Reserve
Total Cost of Production
8 Add Opening Stock-in-process and finished goods
9
Deduct closing stock-in-process and finished goods
D
Cost of Sales
E
Gross Profit ( B-D )
F
Interest on
1. Terms Loans
2. Working Capital
3. Other Loans, if any.
G
Selling, General and Administrative Expenses
18
1st
year
2nd
year
3rd
year
4th
year
5th
year
H
Profit before Taxation ( E- (F+G ))
I.
Provision for Taxes
J. Net Profit ( H-I )
K.
Deprecation added back
L.
Net Cash Accruals
M.
Repayment obligations
1. Towards Terms Loan
2. Towards other loans, if any
Total Repayment
N.
Debt Service Ratio ( L:M )
19
Annexure – IV
Cash Flow Statement
[Amount in Lakh]
Construction
Period
1st
year
2nd
year
3rd
year
4th
year
5th
year
A Sources of Funds
1
Cash Accruals (viz. net profit before Taxation
(item H of Annexure-III to which shall Be added
interest (item F of Annexure III)
2 Increase in share capital Equity/Preference
3 Deprecation
4 Increase in long term loans/debentures
5 Increase in deferred payment facilities
6 Increase in Unsecured loans and deposit.
7 Increase in bank borrowing for working capital.
8 Sales of fixed assets/ investment
9 Others (specify)
Total Sources (A)
B Disposition of Funds
1 Preliminary and Pre-Operative Expenses
2 increase in Capital Expenditure
3 Increase in Current assts
3.1 Inventories
3.2 Others
4 Decrease in long term loans/ debentures
5 Decrease in Deferred Payment facilities
6 Decrease in Unsecured loans and deposits
7 Increase in Investments
8 Interest
9 Taxation
10 Dividend(amount & rate)
11 Other expenses (specify)
Total Disposition (B)
C Opening Balance
D Net Surplus (A-B)
E Closing Balance
20
Annexure –V
Projected Balance Sheet
[Amount in Lakh]
1st year 2nd year 3rd year 4th year 5th year
A. Liabilities
1. Equity Share Capital
2. Reserve and Surplus
3. Term Loans
4. Bank Borrowings for working capital
5. Other liabilities
Total Liabilities
B. Assets
1. Gross Block
2. Depreciation
3. Net Block
4. Investment
5. Current Assets
6. Cash and Bank Balances
Total Assets
21
Annexure –VI
Assessment of Working Capital Requirements
[Amount in Lakh]
1st year 2nd year 3rd year 4th year 5th year
(I). Current Assets
1. Raw materials including stores
1.1 Imported (Month’s consumption)
1.2 Indigenous (Month’s consumption)
2. Other Consumable spares
3. Stock-in-Process (Month’s Cost of Production)
4. Finished Goods (Month’s Cost of Sales)
5. Receivables other than Export an Deferred
Receivables (including Bills Purchase/
Discounted by Banks) (Month’s Domestic Sales
excluding deferred Payment sales)
6. Export Receivables
(including Bills Purchased/Discounted by
banks)(Month’s Export Sales)
7. Advances to Suppliers of Raw Material
and Stores/Spares/Consumables
8. Other Current Assets including Cash and bank
balance and deferred receivables due within one
year (furnish individual details of major items)
Total Current Assets ( I )
(II). Current Liabilities
1. Creditors for Purchases of raw materials
and stores/spares/consumables
(Month’s Purchases)
2. Advance from Customers
3. Accrued Expenses
4. Statutory Liabilities
5. Other Current Liabilities
(furnish individual details of major items)
Total Current Liabilities ( II )
III Working Capital Gap(I-II)
IV Margin for Working Capital
V Bank Borrowings