Bandhan Application Form - MSME Loan

Bank
Date: D D M M Y Y Y Y Branch: Branch Code:

2.5 cm 2.5 cm 2.5 cm Application No. ___________________________________

Please paste latest Please paste latest Please paste latest

BSR Code ___________________________________
photograph of the photograph of the photograph of the
1st Applicant 2nd Applicant Guarantor
and sign across and sign across and sign across Segment ___________________________________
3.5 cm

3.5 cm

3.5 cm
Organisation Details:
1. Name of the Enterprise:

2. Customer Id No. of the Company (For existing A/c):

3. Date of Establishment: D D M M Y Y Y Y

4. Constitution of the Enterprise:

Proprietorship Partnership Co-Op- Society Company (Pvt. Ltd.) Company (Pub. Ltd.)

5. Registration No. (Given by DIC/Directorate of Industries):

6. a) Trade License No.:

b). Valid up to: D D M M Y Y Y Y

8. Business Address:

PIN Code: State

STD

Tel. No.:

Fax No.:

Email ID: _________________________________________________________________________

9. Details of all Promoter(s):

A) Name(s) of Promoters/Proprietor/Partners (Details)*:

1st Applicant 1st Applicant’s DOB: D D M M Y Y Y Y

2nd Applicant 2nd Applicant’s DOB: D D M M Y Y Y Y

B) Customer ID. No(s). (For an existing A/c):

1st ID. No. C) a. Voter ID Card No.:

2nd ID. No. b. Voter ID Card No.:

D) a. AADHAAR Card: b. AADHAAR Card No.:

E) PAN (In absence of PAN, provide the form 60/61)

F) Gender: a. Male Female Others b. Male Female Others

G) Marital Status: a. Married Single b. Married Single

H) Category: a. SC ST OBC/Minority General Others __________________

b. SC ST OBC/Minority General Others __________________

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I) Religion: a.______________________________________________ b. ____________________________________________

J) Mobile No: a. b.

K) Email ID: a.______________________________________________ b. ____________________________________________

L) Residential Address*:

a.

City State PIN Code

b.

City State PIN Code

* (For new connections, ID and Address Proof are to be provided and A/L form for an individual is required which will be attached separately)

M) Present Annual Income (Indicate firm & Non-firm income separately) (In `):

i) Firm Income: _______________________________________, Non-Firm Income: _____________________________________, Total: ___________________________________________

ii) Firm Income: ______________________________________, Non-Firm Income: _____________________________________, Total: ___________________________________________

10. Family Size: a. Adult Children b. Adult Children

11. No. of Dependents: a. b.

12. Monthly Family Expenses: i) ` ________________________ ii) ` ________________________

13. Promoters’ Net Worth: i) ` ________________________ ii) ` ________________________

14. Brief Description of Activity: i) Existing: ________________________ ii) Proposed: ________________________

15. No. of Employees Engaged: i) Existing: ________________________ ii) Proposed: ________________________

16. If the unit is an Ancillary Unit, the undertaking to which it is catering and its address:

17. Names of the Associate Concerns and Nature of the Association:

Name of the Nature of the Nature of Activity Items Traded & Turnover and
Associate Association and Manufactured Profit during
Concerns Amount Invested preceding years

18. How the activity was financed so far (To be filled for existing unit only):
Source of Funds* Security Rate of Repayment Present Amount
Int.(%) per Month Outstanding of Default (if any)
(In `) (In `) (In `)

*Indicates the Name & Address of the sources of funds, e.g. Banks/Financial Institutions/Other (Specify)

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19. Banking/Credit Facilities: (Existing) (In `) _________________________________________________________

Type of facility Limit (`) Outstanding Presently Banking with Securities Repayment
as on Terms Terms
Liability SB A/c

FD A/c

Current A/c

Assets Cash Credit

Term Loan

Others

Total

# It is certified that I am not indebted to any other Bank/Financial Institution other than those mentioned in the table 18 above.

20. Past Performance/Future Estimates: (Actual performance for last two years, estimates for the current year and projections for the 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 the Loan).

(In `) Past Year 2nd Past Year 1st Present Year Next Year
(Estimates) (Projections)

Turnover

Total Expenses

Net Profit

21. Monthly turnover for the last twelve months (In `):

Jan. Feb. Mar. Apr. May. June

July Aug. Sep. Oct. Nov. Dec.

22. Purpose of the Loan:

i) Working Capital for: ______________________________________, Loan amount ______________________________________, Term _________________________________ (Months).

i) Working Capital for: ______________________________________, Loan amount ______________________________________, Term _________________________________ (Months).

23. For Working Capital Requirement:

A) Purchases:
i) General: (Major suppliers/ goods are subject to any quota / price control / Govt. Regulation or any special problems involved in making purchases).
ii) Terms of all purchases: a) Advance payment, if any required to be made.
b) Period and amount of credit available.
iii) Trend of the credit received:

Particulars Past Year 2nd Past Year 1st Present Year Next Year
(Estimates) (Projections)

Average Credit Received (Total)

Maximum Credit Received (Total)

Minimum Credit Received (Total)

B) Sales:
i) General:
(Major buyers or nature of the class of clientele; whether the goods are subject to any quota/ price control/ Government Regulations; after sales service).
ii) Terms of sales:

Particulars Past Year 2nd Past Year 1st Present Year Next Year
(Estimates) (Projections)

a). Percentage of credit Sales

b). Terms of Credit: (Indicate period of
credit; discounts if any, offered for cash
sales or earlier payments for credit sales)
c). Trend of Credit given Average credit
given Max. credit given Min. credit given

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 C) Stock Position:

Particulars Past Year 2nd Past Year 1st Present Year Next Year
(Estimates) (Projections)

Average Stock Carried

Maximum Stock Carried

Minimum Stock Carried

24. Credit Facilities (Required):

Type of Facilities Amount (In `) Purpose/ Details of the Collateral Security Offered
Requirement Immovable/Movable Property Cash Collaterals

25. Cost of the Project

(Please furnish the estimates of Project Costing under the following heads):
Particulars Already incurred (In `) To be incurred (In `) Total Cost (In `)

Cost of the Land including development

Building & Other Civil Works

Plant & Machinery

1) Indigenous

2) Imported

Essential Tools, Spares and Accessories

Testing Equipments

Misc. Fixed Assets

Erection/Installation Charges

Preliminary Expenses

Pre-Operative Expenses

Provision for Contingencies

1) Buildings

2) Plant & Machinery

3) Other Fixed Assets

Margin for Working Capital Required

Total

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26. Means of the Project Finance:

Particulars Amount Already Raised (In `) Amount Proposed to be Raised (In `) Total Fund (In `)

Capital (Specify resources contributing Capital):

Reserves:

Term Loans (Give details):

Unsecured Loans and Deposits:

Deferred Payment arrangements including

Suppliers’ credit:
Subsidy Central Govt./State Govt./Other Agency:

Particulars Amount Already Raised (In `) Amount Proposed to be Raised (In `) Total Fund (In `)

Seed Capital (Indicate Sources):

Internal Cash Accruals:

Other Sources (Specify):

Total

27. Schedule of all Implementation:

Particulars Date of Commencement Expected date of Completion

a) Acquisition of the Land:

b) Development of the Land:

c) Civil works for:

i. Factory Building:

ii. Machinery Foundation:

iii. Administrative Building:

d) Plant and Machinery:

i. Imported:

ii. Indigenous:

e) Arrangement for the Electric Power:

f) Arrangement for Water:

g) Erection of Equipment:

h) Commissioning:

i) Initial procurement of Raw Material:

j) Trial Runs:

k) Commercial Production:

Acknowledgement (To be returned to the Customer)

We have received MSME Loan application from Mr./Ms./M/s _____________________________________________________________________________________________________for

Loan Amount of ` _________________________________________________ on _____________________________________________________________________.

For Bandhan Bank

For Bandhan Bank

Date: D D M M Y Y Y Y

Place : ________________________________
Branch Seal Authorised Signatory
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28. Arrears in Statutory Payments (If any)

Income Tax (In `)

Sales Tax (In `)

Provident Fund (In `)

Employees State Insurance Corporation (In `)

Other (Specify) (In `)

29. Details of the Guarantor:

i) Name:

ii) Date of Birth D D M M Y Y Y Y Age: Yrs. Aadhaar Card No.:

iii) Father’s/Husband’s Name:

iv) PAN of the Guarantor: Voter ID No.:

v) Guarantor’s CIF No. and A/c No.(If any) :

vi) Present Address:

vii) Permanent Address:

viii) a. Educational Qualification: _______________________________________________ b. Profession with the designation: __________________________________________

ix) Relationship with the Applicant (if any): ______________________________________ x) Personal Liability: ` _____________________________________________________

xi) Monthly Income: ` _________________________________________________________ xii) Monthly Expenditure: ` _________________________________________________

xiii) Net Worth (Assets - Liabilities) : ` __________________________________________

Reference Details:

Name: Mr. /Mrs. /Ms._____________________________________________________________ Name: Mr. /Mrs. /Ms._________________________________________________________

Address: ________________________________________________________________________ Address: ___________________________________________________________________

PIN Code: _______________________________________________________________________ PIN Code: ___________________________________________________________________

Relationship with the Applicant: Friend Relative Relationship with the Applicant: Friend Relative

Email ID: ________________________________________________________________________ Email ID: __________________________________________________________________

Mobile/Landline No.: ____________________________________________________________ Mobile/Landline No.: _______________________________________________________

Declaration

Relationship Declaration: Details of relationship with the Director/Senior Officer of Bandhan Bank

Name of the Director/Senior Officer _____________________________________________ Relationship with Director/Senior Officer _____________________________________

I/We hereby declare that all the particulars and information furnished in the application form are true, correct, complete and up-to-date in all respects. I/We have not withheld any information.
I/We confirm that I/we had no insolvency proceedings initiated against me/us, nor have I ever been adjudicated insolvent and further confirm that I/We have read and understood the contents.
I/We are aware that the fees paid by me/us are non-refundable. I/We are aware about the rate of Interest charged by Bandhan Bank. I/we understand that the document submitted shall not be
returned to me/us. The sourcing channel has not collected any cash or cheque other than PF to be deducted by Bandhan Bank. I/We also confirm that the Loan proceedings will be utilised for
purchase related to the business mentioned in this application and not for any other speculative purpose. I/We also authorise Bandhan Bank or its agent to make references and inquiries related
to the information in this application which Bandhan Bank considers necessary. I/We also authorise Bandhan Bank to exchange/share all the information relating to my/our Loan details and
repayment history to other Banks/Financial institutions/Credit Bureaus/Agencies as may be required, I/We shall not hold Bandhan Bank liable for use of this information. I/We undertake to inform
Bandhan Bank regarding any change in my residence/employment/occupation/transfer and to provide any other information that Bandhan Bank may require. I/We further agree that my Loan
shall be governed by the rules of Bandhan Bank which may be in force from time to time. Bandhan Bank reserves the right to reject any application without providing any reason. I/We undertake
to bear processing, service, documentation charges etc. stipulated by the Bank from time to time. I/We agree, note and understand that Bandhan Bank shall be entitled at its sole discretion to call
back, the entire Loan/advance whether due and payable or not at any time, without assigning any reason and enforce its rights, remedies and securities.

Date: D D M M Y Y Y Y

Place : ________________________________ Signature of the Co-Applicant

Signature of the Applicant

Signature of the Guarantor

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