Application ID: (For office use)

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS

EMPLOYMENT GENERATION PROGRAMME (PMEGP)
12 Name of the project / business activity proposed :

13 Amount of loan required (in Rs.)

Capital Expenditure Loan
Working
Building Type Workshed Machinery/ Pre
Capital /
Building Equipment/ Operative
Cash Credit Total
etc. Furniture Cost
Limit
Rented 0 30000 22000 52000 104000
Details of earlier or current Loan/Grant and subsidy availed from
14 Central/State Govt. Scheme/ or any other Similar Scheme.
Activity of the Project with Address Amount Year of Sanction

I certify that all information furnished by me is true; and that I and any of my dependent have not
borrowed any money under subsidy linked scheme from any Central / State Government or bank for
establishing any such project

Place:
Date: Signature of the Applicant

For Official Use only: (Rejected / to be placed before District Task force Committee)
Reason (if Rejected):

Place: Signature, Name & Designation of Officer

Date:
 NOTE

• Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North

East Reason/Hill Boarder Area and 10% for General
• Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for
service unit.
• Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own
Contribution over and above the prescribed limit.
• VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector
above Rs.5 lakhs
• Application should be submitted complete in all respect along with attested copies of the
following documents:
1. Certificate of qualification-academic and technical (if project cost above 5 lakhs under
service industry or above 10 lakhs under Manufacturing industry)
2. Relevant Certificate for SC/ST/OBC/Minority/Ex-Servicemen/PHC
3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks)
then submit photocopy of the certificate
 DATA INPUT SHEET

Preference for sponsoring agency of the project : (mark √ )

Unit Location (As per revenue record) : (mark √ )
KVIC KVIB DIC √ COIR Board
1.1 Name of the Applicant/Institution
Rupamani Swargiary
1.2

2 Gender Male Female √ Transgender

3 Address of the Proposed location of Unit: Rural Urban √

5 Whether the applicant belongs to (mark √) ###

Ex- Service Aspirational
SC ST OBC PHC Minority Hill Border Area General
man Districts
√

Whether the project Manufacturing

6
(mark √) Unit
Service Unit √
8 Name of the project / business activity proposed :
M/S RUPMANI BEAUTY PARLOUR

Legal Status:

Land 2000 ###

BUILDING DETAILS
Particulars Area Rate/Sq.ft Amount in Rs.
Room ls ls 0.00
0.00
0.00
0.00
0.00
0.00
0.00

MACHINERY DETAILS
Particulars Qty. Rate Amount in Rs.
Brick making machine 1 850000.00 850000.00
Electrification 1 20000.00 20000.00 Male

Trans
###
KVIC
KVIB
DIC

Rural

Total No

d. Preliminary & Pre-operative Cost : 8000.00 SC

e. Furniture & Fixtures : 30000.00

f. Contingency/Others/Miscellaneous 14000.00

Working Capital : 52000.00

Manu
 Means of Financing Unde

Own Contribution : 5%
Bank Finance : 95%
Margin Money (Govt. Subsidy) : 25%

DETAILS OF SALES Own

Rate/ Quantity Amount in Rs.
Particulars of Products
Unit
Facial, Hair strengthten, Hair cut etc ls ls 800000.00
Bridal makeup, Party makeup etc ls ls 750000.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 1550000.00

RAW MATERIALS
Particulars Unit Rate/Unit Reqd. Unit Amount In Rs.
Various types of facial kit, cream , powder , lot ls ls 200000.00
Other raw materials ls ls 60000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 260000.00

WAGES
No. of Amount in Rs.
Particulars
Worker Total Month 12
Skilled worker 2 8000.00 192000.00
Unskilled worker 1 5000.00 60000.00
0.00
0.00
0.00
0.00
0.00
Total 3 252000.00

SALARY DETAILS
No. of Wages Per Month Amount in Rs.
Particulars
Staff Total Month 12
Manager cum supervisor 1 self 0.00
Office staff 1 5000.00 60000.00
0.00
0.00
0.00
Total 2 60000.00

WORKING CAPITAL ESTIMATE

Element of Working Capital No. of Days

Stock in process

Finished goods

Receivable by

POWER ESTIMATE
Power Requirement

Repair and Maintanance Rs. 0.00

Power and Fuel Rs. 1000.00

Other Overhead Expenses Rs. 2000.00

Telephone Expenses Rs. 1000.00

Stationery & Postage Rs. 2000.00

Advertisement & Publicity Rs. 2000.00

Building Rent Rs. 24000.00

Other Miscelleneous Expenditure Rs. 3000.00

Rate of Interest

Depreciation
On Building
On Machinery

INTRODUCTION
ABOUT THE BENEFICIARY
 PROJECT AT A GLANCE - TOP SHEET
1 Name of the Beneficiary Rupamani Swargiary

2 Constitution (legal Status) Individual

3 Father's/Spouce's Name W/O Phanindra Adhikary

4 Unit Address : Vill/Town - Abhayapuri

0
Taluk/Block: Tapattary
District : Bongaigaon
Pin: 783384 State: Assam
E-Mail : 0
Mobile 6362504219
5 Product and By Product Beauty Parlour

6 Cost of Project : Rs. 5,00,000

Name of the project / business
M/S RUPMANI BEAUTY PARLOUR
activity proposed :
7 Means of Finance
Term Loan Rs. 4,75,000
KVIC Margin Money Rs. 1,25,000
Own Capital Rs. 25000.00

8 Debt Service : 3.58

Coverage Ratio

9 Pay Back Period : 5 Years

10 Project : 0 Months
Implementation
Period

11 Break Even Point : 41.82%

12 Employment : 5

13 Power Requirement : 2 KW

14 Major Raw materials : Various types of facial kit, cream , powder , lotion, face wash,Other raw m

15 Estimated Annual : Rs. 15,50,000

Sales Turnover

PMEGP Project Report Page 9

 DETAILED PROJECT REPORT
1 INTRODUCTION :

2 ABOUT THE BENEFICIARY :

3 COST OF PROJECT
A. Fixed Capital Investment
a. Land : 2000 Own

b. Workshed Area Sq.ft Rate in Rs. Amt. In Rs.

Room ls ls 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00
#REF!
C. Machinery Qty. Rate Amount in Rs.
Brick making machine 1 850000.00 850000.00
Electrification 1 20000.00 20000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00

PMEGP Project Report Page 10

 d. Preliminary & Pre-operative Cost : Rs. 8000.00

e. Furniture & Fixtures : Rs. 30000.00

f. Contingency/Others/Miscellaneous Rs. 12000.00

Total Capital Expenditure : Rs. 50000.00

Working Capital : Rs. 300000.00

Total Cost Project : Rs. 350000.00

3.1 Means of Financing :

Own Contribution 5% Rs. 17500.00

Bank Finance : 95%

Term Loan Rs. 47500.00
Working Capital Rs. 285000.00

Total Rs. 332500.00

Margin Money (Govt. Subsidy) From KVIC 25% Rs. 87500.00

Margin Money Subsidy received From KVIC will be kept in term deposit as per norms of
PMEGP in the name of Beneficiary for three years in the financing branch.

3.2 STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :
TERM LOAN

Interest @
Year Opening Balance Installment Closing Balance
0.00%
1st 47500 0 47500 0
2nd 47500 9500 38000 0
3rd 38000 9500 28500 0
4th 28500 9500 19000 0
5th 19000 9500 9500 0
6th 9500 9500 0 0
7th 0 0 0 0
8th 0 0 0 0

WORKING CAPITAL

Interest @
Year Opening Balance Installment Closing Balance
0.00%
1st 285000 0 285000 0
2nd 285000 57000 228000 0
3rd 228000 57000 171000 0
4th 171000 57000 114000 0
5th 114000 57000 57000 0
6th 57000 57000 0 0
7th 0 0 0 0
8th 0 0 0 0

PMEGP Project Report Page 11

3.3 STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:
WORKSHED @ 0.00%
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Opening Balance 0 0 0 0 0
Depreciation 0 0 0 0 0
Closing Balance 0 0 0 0 0
MACHINERY @ 0.00%
Opening Balance 0 -18300 -34770 -49593 -62934
Depreciation 18300 16470 14823 13341 12007
Closing Balance -18300 -34770 -49593 -62934 -74941
TOTAL DEPRECIATION
Workshed 0 0 0 0 0
Machinery 18300 16470 14823 13341 12007
Total 18300 16470 14823 13341 12007

4 Schedule of Sales Realization :

4.1 Details of Sales
Rate/ No. of Amount in Rs.
Particulars of Product Pair/Unit Pair/Unit
0
Facial, Hair strengthten, Hair cut etc 0.00 0 1550000.00
Bridal makeup, Party makeup etc 0.00 0
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
Total 1550000.00

4.2 Capacity Utilization of Sales

Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year

Capacity Utilization 70% 80% 90% 90% 90%

Sales / Receipts 1085000 1240000 1395000 1395000 1395000

5 Rawmaterials :
Particulars Unit Rate/unit Reqd.Unit Amount in Rs.
Various types of facial kit, cream , 0 ls ls 200000.00
Other raw materials 0 ls ls 60000.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
Total 260000.00
5.1 Wages :
No. of Wages Amount in Rs.
Particulars Worker Per Month (Per Annum)
Skilled worker 2 8000.00 192000.00
Unskilled worker 1 5000.00 60000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 3 252000.00

PMEGP Project Report Page 12

5.2 Repairs and Maintenance : Rs. 3000.00

PMEGP Project Report Page 13

5.3 Power and Fuel : Rs. 1000.00

5.4 Other Overhead Expenses : Rs. 2000.00

6 Administrative Expenses :
6.1 Salary
Manager cum supervisor 1 self 0.00
Office staff 1 5000.00 60000.00
0 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
Total 2 60000.00

6.2 Telephone Expenses 1000.00

6.4 Stationery & Postage 2000.00

6.5 Advertisement & Publicity 2000.00

6.6 Workshed Rent 24000.00

6.7 Other Miscellaneous Expenses 3000.00

Total 92000.00
7 Capacity Utilization of Manufacturing & Administrative Expenses :
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Capacity Utilization 70% 80% 90% 90% 90%
Manufacturing Expenses
Raw materials 182000 208000 234000 234000 234000
Wages 176400 201600 226800 226800 226800
Repairs & Maintenance 2100 2400 2700 2700 2700
Power & Fuel 700 800 900 900 900
Other Overhead Expenses 1400 1600 1800 1800 1800
Administrative Expenses
Salary 60000 60000 60000 60000 60000
Postage Telephone Expenses 700 800 900 900 900
Stationery & Postage 1400 1600 1800 1800 1800
Advertisement & Publicity 1400 1600 1800 1800 1800
Workshed Rent 24000 24000 24000 24000 24000
Other Miscellaneous Expenses 2100 2400 2700 2700 2700
Total: 452200 504800 557400 557400 557400
8 Assessment of Working Capital :
Particulars Amount in Rs.
Sale 1550000.00

Manufacturing Expenses
Raw Material 260000.00
Wages 252000.00
Repair & Maintenance 3000.00
Power & Fuel 1000.00
Other Overhead Expenses 2000.00

Production Cost 518000.00

Administrative Cost 92000.00
Manufacturing Cost 610000.00

PMEGP Project Report Page 14

 Working Capital Estimate :
Element of Working Capital No of Days Basis Amount in Rs.
0 30 Material Cost 26000.00

Stock in process 7 Production Cost 12087.00

Finished goods 5 Manufacturing Cost 10167.00

Receivable by 25 Manufacturing Cost 50833.00

Total Working Capital Requirement Per Cycle 99087.00

9 Financial Analysis
9.1 Projected Profit & Loss Account :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Sales / Receipts 1085000 1240000 1395000 1395000
1085000 1240000 1395000 1395000
Manufacturing Expenses
Raw materials 182000 208000 234000 234000
Wages 176400 201600 226800 226800
Repairs & Maintenance 2100 2400 2700 2700
Power & Fuel 700 800 900 900
Other Overhead Expenses 1400 1600 1800 1800
Depreciation 18300 16470 14823 13341
Production Cost 380900 430870 481023 479541
Administrative Expenses
Salary 60000 63000 66150 69458
Postage Telephone Expenses 700 800 900 900
Stationery & Postage 1400 1600 1800 1800
Advertisement & Publicity 1400 1600 1800 1800
Workshed Rent 24000 24000 24000 24000
Other Miscellaneous Expenses 2100 2400 2700 2700
Administrative Cost 89600 93400 97350 100658
Interest on Bank credit @ 0%
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Cost of Sale 470500 524270 578373 580199
Net Profit Before Tax 614500 715730 816627 814801
Less Tax 0.00 0.00 0.00 0.00
Net Profit 614500 715730 816627 814801

9.2 CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit 614500 715730 816627 814801
Add :
Depreciation 18300 16470 14823 13341
TOTAL - A 632800 732200 831450 828142
Payments :
On Term Loan :
Interest 0 0 0 0
Installment 0 9500 9500 9500
On Working Capital
Interest 0 0 0 0
TOTAL - B 61750 9500 9500 9500
D.S.C.R = A/B
10.25 77.07 87.52 87.17
Average D.S.C.R

PMEGP Project Report Page 15

9.3 PROJECTED BALANCE SHEET :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
LIABILITIES :
Beneficiary's Capital 17500 17500 17500 17500
Profit 614500 715730 816627 814801
Term Loan 47500 47500 38000 28500
Working Capital Loan 285000 285000 228000 171000
Current Liabilities 0 0 0 0
Sundry Creditors 0 0 0 0
964500 1065730 1100127 1031801
ASSETS :
Gross Fixed Assets : 30000 11700 -4770 -19593
Less : Depreciation 18300 16470 14823 13341
Net Fixed Assets 11700 -4770 -19593 -32934
Preliminary & Pre-Op. Expenses 8000 6000 4500 3375
Current Assets 285000 285000 228000 171000
Cash in Bank/Hand 667800 785500 891720 893735
Total 964500 1065730 1100127 1031801

9.4 CASH FLOW STATEMENT :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit 614500 715730 816627 814801
Add : Depreciation 18300 16470 14823 13341
Term Loan 47500 47500 38000 28500
Working Capital Loan 285000 285000 228000 171000
Beneficiary's Capital 17500 0 0 0
Total 982800 1064700 1097450 1027642

Total Fixed Capital Invested 50000

Repayment of Term Loan 0 9500 9500 9500

Repayment of WC Loan 0 57000 57000 57000
Current Assets 285000 285000 228000 171000
Total 285000 351500 294500 237500

Opening Balance 0 697800 1411000 2213950

Surplus 697800 713200 802950 790142
Closing Balance 697800 1411000 2213950 3004092

9.5 BREAK EVEN POINT AND RATIO ANALYSIS :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Fixed Cost 107900 109870 112173 113999
Variable Cost 380900 430870 481023 479541
Total Cost 488800 540740 593196 593540

Sales 1085000 1240000 1395000 1395000

Contribution (Sales-VC) 704100 809130 913977 915459

B.E.P in % 15.32% 13.58% 12.27% 12.45%

Break Even Sales in Rs. 166271 168377 171209 173715

Break Even Units #VALUE! #VALUE! #VALUE! #VALUE!

Current Ratio 4.62 4.29 3.43 2.57

PMEGP Project Report Page 16

 Net Profit Ratio 56.64% 57.72% 58.54% 58.41%

PMEGP Project Report Page 17

 This Project Report has been prepared based on the data furnished by the beneficiary whose details are
given in the application.
Place :
Date:
Prepared by :
Full Name : RUPAMANI SWARGIARY

Signature of the Beneficiary

PMEGP Project Report Page 18

PMEGP Project Report Page 19
LED PROJECT REPORT

PMEGP Project Report Page 20

 1.00

PMEGP Project Report Page 21

PMEGP Project Report Page 22
PMEGP Project Report Page 23
 PROJECT REPORT FOR

Affix latest
attested
Photograph

1 Name of the Beneficiary Rupamani Swargiary

1
2 Constitution (legal Status) Individual

3 Father's/Spouce's Name #REF!

5 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: #REF!
Phone #REF!
E-Mail #REF!

6 Background of the Proprietor/Partners/Directors : Furnished detailed information in the DPR

7 Name of Business House/Group if any :

8 Details Other Companies/Units in the group :

Other Companies / Units in the Group (Rs. in Lakhs)
Name & Address Business Equity Reserves Loans Turnover *P.B.T **P.A.T
of Company / Unit

* Profit Before Tax ** Profit After Tax

`

8.1 How the activity was financed so far : ( To be filled up in case of existining unit Only )
*Source of Funds Security Rate of Repayment per Present O/s Amount of Default
Interest Month ( Rs. in '000 ) (if any)

8.2 If the Unit is an ancillary one, undertaking to

which it is catering and its address :
8.3 Employment : Present Proposed
Skilled worker 2
Unskilled worker 1
0 0
0 0
0 0
0 0
0 0
Manager cum supervisor 1
Office staff 1
0 0
0 0
0 0
Total 5

9 Project Details for Proposed New Unit : Copy of detailed project report is enclosed.
a Expansion / Mordenisation :

b Setting up of New unit :

c Activity for proposed new unit :

d Product / Item proposed to undertake :

9.1 Capacity (Furnish the details of Installed capacity & production : (No. in Units/ Qty. in Kg./Volume in liter per annum)
Capacity is arrived at on the basis of Days working on shift basis
Product & Present Installed Maximum Prod. Proposed Installed Maximum Prod.
By-product if any Capacity Achieved Capacity of 1st Year envisaged
70.00% 380900

9.3 State the manufacturing process in brief :

9.4 Has the proposed process ever been tried in the
country or newly adopted? :

9.5 Technical Arrangements :

9.6 Describe arrangement for Key Official

for managing the proposed unit :
Technical Manpower

Administrative Manpower

Accounting personnel

9.7 Particulars of Land Existing Proposed

Location of the Land :
Area of Land
Status of the Land
Nature of Land
Availability of Water :

9.8 Particulars of Building Existing Proposed

(Enclose the plan & Estimation for the proposed Building) Area Value in Rs. Status Area Value Status
Factory Building :

Ancillary Building

Storage

Total 0.00 0.00

9.9 Plant and Machinery Existing (Value in Rs.) Proposed (Value in Rs.)
Indigenous 0.00

Imported

(Enclose the plan layout of the existing plant and machinery )

9.10 Rawmaterials / Components
Req. of Raw material/Components/Chemicals Qty. in Nos./Kgs./Ton Rate/Nos./Kgs/Tons Value in Rs.

Total 0.00

9.11 Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)
Particulars of Utilities Contracted Load Connected Load Further requirement
in HP/KW/W in HP/KW/W in HP/KW/W
Power

Water

Fuel

Others (Specify)
9.12 Environment Aspect of the Project :

9.13 Requirement of Manpower for the Project :

Particulars of Manpower Total Requirement Salary/Wages per month Cost per Annum
Skilled worker 2 8000.00 192000.00
Unskilled worker 1 5000.00 60000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Manager cum supervisor 1 self #VALUE!
Office staff 1 5000.00 60000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 5 #VALUE!

9.14 Schedule of Implementation : BAR CHART

Activities Date of Commencement Expected Date of Completion
a. Acquisition of Land
b. Development of Land
c. Civil Works for Factory / Building
Machinery / Foundation etc..
d. Plant & Machinery
Imported
Indigenous
e. Arrangement for power
f. Arrangement for water
g. Errection of equipment
h. Commissioning
I. Procurement of Raw materials/Chemicals
j. Trail Runs
k. Commercial Production
10 Cost of Project :
(Rs. in '000)
Sr.No. Particulars Already Incurred To be Incurred Total Cost
A Land including Development 0.00 0.00

B Building & Other Civil Works 0.00 0.00

C Plant and Machinery

1. Indigenous 0.00 0.00
2. Imported 0.00

D Furniture & Fixture 30000.00 30000.00

E Testing equipment 0.00

F Miscellaneous Fixed Assets 0.00

G Errection & Installation Charges 0.00

H Contingency 14000.00 14000.00

I Preliminary & Pre-Op. Cost 8000.00 8000.00

J Provision for
1. Buildings 0.00
2. Plant & Machinery 0.00
3. Other Fixed Assets 0.00

K Working Capital for one 300000.00 300000.00

Operating Cycle

L Total 0.00 352000.00 352000.00

 11 Means of Financing :
(Rs. in '000)
Sr.No. Particulars Amount already Amount Proposed Total
Raised to be Raised
A Equity / Promoters Contribution 17500.00 17500.00

B Reserves 0.00

C Term Loans 332500.00 332500.00

D Unsecured Loans and Deposits 0.00

(Indicate sources, roi, repayment etc)

E Deferred Payment 0.00

Arrangements including Suppliers credit

F Subsidy
Central Government 87500.00 87500.00
State Government 0.00

G Seed Capital 0.00

H Internal Cash Accruals 0.00

I Other Sources (Specify) 0.00

J Total 0.00 350000.00 350000.00

11.1 In case internal accruals are taken as

source of finance explain the basis of
estimation of internal accruals :

11.2 Indicate source from which expenditure

already incurred has been financed :

11.3 % of Promoters contribution of the :

total cost of project
 12 Marketing & Selling Arrangements of the Product :

13 Projected Profitability : Projected Profitability Statement given in the

Detailed Project Report.

14 Projected Cash flow Statement : Projected Cash flow Statement given in the
Detailed Project Report.

% of Cash Sales in Total Sales :

Period in which payment is received Days

in respect of Credit Sales

Average Credit Available on Purchase : Days

15 Working Capital Required for the : Rs. 300000.00

anticipated turnover

16 Repayment Programme : Detailed Repayment programme for Term loan and

Working capital loan have been given in the DPR.

17 Details of Securities to be Offered :

17.1 Primary ( Furnish details for term loan and : :

working capital loan separately )
17.2 Collateral, if any (Details) :

17.3 Details of Guarantor(s) :

1. Name
2. Residential Address :

3. Occupation :
4. Details of movable & immovable
properties owned by him /her/other
family members

5 Details of any other similar guarantees:

if any, given to other institutions

18 Government Consents :
(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)

19 DECLARATION

I / We hereby declare that the information given herein before and the statements and other
papers enclosed are, to the best of our knowledge and belief, true and correct in all particulars

Date : 0 Signature of the Borrower

Place : 0 Name & Designation (In case of Regd. Inst.)
 Project Report on

Prepared By:
#REF!
District Industries Center
#REF!
#REF!
#REF! State: #REF!
e-Mail:
Ph. No.: Fax: