State Bank of India
Small Scale Industries
Application Form For Credit Facilities of over Rs. 50 lacs & upto Rs. 5 crores

1.1 Name of the Unit
(In block letters)
1.2 Constitution: (Proprietary / Partnership Firm /
(Please strike out whichever is not Private Limited Company /
applicable) Public Limited Company /
Co-operative Society)
1.3 Name of the business house / group :
(if any)
2.1 Registration No. :
(As given by the District Industries
Centre / Directorate of Industries)
2.2 Date of Incorporation /
Commencement of Business:
3 Business Address with Telephone / Telex Number
3.1 Registered Office:
3.2 Administrative Office:
3.3 Factory:
4. Background of the (Please furnish for
Proprietor / Partners / Directors each person as per the
Appendix 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 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)
State Bank of India
7. Past Performance
(To be filled by the existing unit only)
(Indicate in 000s of Rs.)
Particulars Last Year Last but One year Last but two years
Turnover
Net Profit
Retained Profit
Monthly Turnover for last twelve months
Jan Feb Mar Apr May Jun
Jul Aug Sep Oct Nov Dec
8. Arrears in Statutory payments (if any)
a) Income tax
b) Sales 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
10. Name of the associate concern(s), if any
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. Employment Present Proposed
Executives
Supervisory
Administrative / Office Staff
Skilled Labour
Unskilled Labour
State Bank of India
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 f low, (etc).
12.3 Capacity: (No . of Units / Quantity in kg. / Volume in litre per annum)
Capacity for each
product
Licensed Installed Operating
Number of working days in a month
and Number of shifts in a day:
12.4 Locational advantages of existing
and /or proposed premises and with
reference to
i) absence of civic restrictions
ii) proximity to the source of raw materials
iii) market for the product
i) availability of
a) power
b) water
c) labour
d) transport
v) whether clearance has been
obtained from the pollution control authority?
State Bank of India
12.5 Land & Building
Area / Plinth Area (in sq. metres) 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)
Enclosures:
a) certified photo copy of sale / lease deed
b) certified photo copy of the Govt. order converting the land into
industrial land, if applicable
c) locational map
d) certified photo copy of the site plan of the land and blueprints of the
buildings duly approved by Corporation / Municipality / Panchayat.
12.7 Particulars of Machinery & other fixed assets :
As per Appendix II
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.
State Bank of India
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 it is
available
(enclose proforma invoices in respect of each item, if available
13. (Give comments on requirement, availability / adequacy, qualitative aspects, etc.)
13.1 Power
Contracted Loan
Connected Load
Future power consumption
(in No. of units) per month
Standby arrangements
(enclose certified Xerox copy of sanction for power connection)
13.2 Water
(Enclosed certified Xerox copy of sanction for water connection)
13.3 Fuel
13.4 Others (specify)
State Bank of India
14. Quality Control
14.1 Details of arrangement 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 the SSI sector
15.2 Name of the major customers
15.3 Region / Area where the product
is / will be sold
15.4 Extent of competition and No. of
units engaged in similar line in the
area
15.5 How does the unit
meets / proposes to meet the
competition (comment on the
competitive advantages enjoyed
by the unit)
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 has
been appointed, its name, period
of contract, commission payable,
period by which the bills will be
paid by it etc.
(enclose copies of agreement,
wherever such agreement has been
entered into)
State Bank of India
15.6 Nature and volume of
orders / enquiries on hand
(certified Xerox copies to be
furnished)
15.7 If the units is export oriented,
please furnish exporter code no., if
preceding three years.
Code No.:
Name of the Product
Exported
Name of the Country where
Exported
F.O.B Value in US $
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
B 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
L Total
State Bank of India
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
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
Accruals
I Other Sources
(specify)
J Total
16.1 In case internal accruals are taken as
Source of finance, explain the basis
For estimation of internal accruals by
Means of a statement
17.2 Indicate sources from which
expenditure already incurred has
been financed
17.3 Promoter’s contribution to the
project as % of the total cost
(please furnish list of person / firms
who would be contributing to the
promoter’s share of the capital and
the respective amounts and their
relationships)
State Bank of India
17 Schedule of Implementation
Please indicate the progress made so far in the implementation of the project and
Furnish the scheduled of implementation as follows
Date of
Commencement
Expected 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 Projection
(to be given for the next five years) please furnish data on
19.1 Projected profitability as per Appendix III
19.2 Projected cash flow statement as per Appendix IV
19.3 Projected balance sheet as per Appendix V
19.4 Working capital requirement as per
Appendix VI
Percentage of Cash Sales to 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
Appendix VI)
20.5 Non-Fund Based Limits, i.e. other
Forms of assistance (e.g. L/Cs, Bank
Guarantee, etc.)
21 Repayment Programme
State Bank of India
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)
22.3.1 Name
22.3.2 Residential Address
22.3.3 Occupation (if in service, name & address of
his /her employer)
22.3.4 Details of Movable & Immovable
Property(ies) owned by him / her & other
Dependent family members
22.3.5 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, details thereof.
I / We certify that all information furnished by me / us is true; that I / We have no
borrowing arrangements of the unit with any bank except as indicated in the application;
that there is no over dues / statutory dues against me / us / promoters except as indicated
in the applications; 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 and 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 / ver ify, my / our assets,
books of accounts, etc., in our factory / business premises as given above.
Signature of the Borrower
(Name & Designation)
Date
Place
State Bank of India
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 of
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
Forms as per Appendix – SSI-I to Appendix – SSI- VI given hereafter should also be
submitted along with the application