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1. STATE:*  
2. NAME OF DISTRICT:*  
2. NAME OF CITY :*  
3. NAME OF THE BRANCH :*  
4. CITY MSME CENTER | Regional Offices  
5. NAME OF THE ENTERPRISE :*  
6. REGD. OFFICE ADDRESS:*  
7. ADDRESS OF FACTORY / SHOP*  
8. WHETHER BELONGS TO SC/ST/OBC/ MINORITY COMMUNITIES
9. TELEPHONE NOs. (OFFICE):*  
10. EMAIL ADDRESS:*    
11. PAN CARD NO.:
12. DATE OF  ESTABLISHMENT:*  
13. NAME OF PROPRIETOR / PARTNERS / DIRECTORS OF COMPANY AND THEIR ADDRESSES:*
NAME AGE(Year) ACADEMIC QUALIFICATIONS RESIDENTIAL ADDRESS TEL NO.(Residence) EXPERIENCE IN THE LINE OF ACTIVITY(Years)
 
14. Sub sector  : Enterprises 
15. Activity: Existing:     
Proposed(#)

# If a different activity other than the existing activity is proposed.
16. NAMES OF ASSOCIATE CONCERNS AND NATURE OF ASSOCIATION:
NAME OF ASSOCIATE CONCERN ADDRESSES OF ASSOCIATE CONCERNS PRESENTLY BANKING WITH NATURE OF ASSOCIATION EXTENT OF INTEREST AS A PROP./ PARTNER/DIRECTOR OR JUST INVESTOR IN ASSOCIATE CONCERN
17. Relationship of Proprietor/Partner/Director with the officials of the Bank/Director of the Bank
18. CREDIT FACILITIES (EXISTING)*
Type of facilities Limit (In lacs) Outstanding as on Presently banking with Security Lodged Rate of interest(%) Repayment terms(Months)
Current account
Cash Credit
Term Loan
LC/BG
If Banking with this Bank, customer No. be given here.
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 in 18(a) above.
19. CREDIT FACILITIES (PROPOSED) : * please Enter Any Amount more then 1
Type of facilities Amount (in lacs) 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 details in column 12)  
Cash Credit              
Term Loan              
LC/BG              
20. 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 Contribution being made by the promoters Loan required
Details of Collateral Security offered, if any, including 3rd party guarantee*

(*As per RBI guidelines banks are not to take collateral security for loans upto Rs.10 lakhs to MSME units)
21. 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 (Net worth in case of companies)
22.
Statutory obligation Whether complied with (Write Yes/No). Remarks
1. Registration under Shops and Establishment Act
2. Registration under MSME (Provisional/Final)
3. Drug Licence
4. Latest Sales tax return filed
5. Latest Income tax return filed
6. Any other statutory dues remaining outstanding
23.
SPACE FOR PHOTO

To be submitted to the Branch along with other documents.
SPACE FOR PHOTO

To be submitted to the Branch along with other documents.
SPACE FOR PHOTO

To be submitted to the Branch along with other documents.
24 Check List :* Check List
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 applications; that there is no overdue/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 Reserve Bank of India or any other agency as authorized by you, may, at any time, inspect/verify my/our assets, books of account etc. in our factory/business premises as given above.
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