State Bank of India
Small Scale Industries
Application Form For credit facilities up to Rs. 10 lacs

Note : Item 18 to be filled in by those applying for credit facilities above Rs. 50,000/-
1. Name of the Unit:
Constitution (Please (Proprietary / Partners /
strike out which ever Co-operative Society)
is not applicable)
2. Registration No.: (as given by the District Industries Centre /
Directorate of Industries)
3. Business Address:
Residential Address:
4. Background (To be filled up for each individual)
4.1 Name(s) of the Proprietor / Partners
Surname Name Father’s / Husband’s Name Age Sex
4.2 Whether the applicant belongs to Yes / No
Scheduled Caste / Tribe /Minority
Community. If yes, please furnish
proof thereof.
4.3 Whether the applicant is Ex- Yes / NO
Serviceman. If yes, please furnish
proof thereof.
4.4 Present annual income of the family
with brief details of the sources
(Indicate farm income & non-farm
income separately)
State Bank of India
5. Size of the applicant’s family Adult ______ Children _____
6. Please furnish ration card No. and
Name of the Issuing Office
7. Size and particulars of land
holdings, if any, in the name of the
applicant of family members
8. Minimum amount required per Rs. ______________
month for family maintenance
9. Cost of the project Fixed Assets RS. ________
Current Assets Rs. ________
Total Rs. ________
10. Brief description of the industrial
activity
10.1 Existing
10.2 Proposed
11.1 Number of persons presently (to be filled in case of existing
unit only)
11.2 Number of persons proposed to be
Employed
12. How the activity was financed so far (to be filled in case of existing
unit only)
Source of
Funds (*)
Security Rate of Int. Repayment
per Month
Present
Outstanding
Amount of
Default (if
any)
(*) (Indicate name & address of the sources of funds, e.g. banks / financial institutions /
other (specify)
13. Raw materials required (quantity) and sources of supply:
14. Location of the market for the product(s):
15. Financial Projections:
Particulars 1st Year 2nd Year 3rd Year
Turnover
Raw Material
Purchases
Other Expenses
Profit
(Indicate the assumptions based on which the above figures have been worked out)
State Bank of India
16. Purpose of the new loan
17. Amount of loan required
18. Means of Financing
18.1 Promoter’s contribution
18.2 Subsidy
18.3 Seed Capital
18.4 Loan (Working Capital / Term Loan)
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 this application;
that there is no over dues / statutory dues against me / us except as indicated in this
application; that no legal action has been / is being taken by 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 you, your representatives, representatives of the Reserve Bank of India / National
Bank for Agriculture and Rural Development / Small Industries Development Bank of
India 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.
(Affix a photo, in case of thumb impression)
Date Signature / Thumb impression of the Borrower
Place