ONLINE APPLICATION FORM FOR MSME LOAN

# Colored input boxes with symbol accepts only numeric values

CHECK LIST OF DOCUMENTS FOR MSME LOAN APPLICATION

1.	Name of the Enterprise *:
2.	Registered Office Address:
3.	Address of Factory/Shop
4.	Category	General SC ST OBC Minority
5.	Telephone No.	#
6.	Email Address*:
7.	Mobile No.*	#
8.	PAN Card No.*
9.	Constitution :
10.	Date of Establishment*:	DD SELECT 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM SELECT 01 02 03 04 05 06 07 08 09 10 11 12 YYYY SELECT 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
11.	State :	ANDAMAN & NICOBAR ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATISGARH DADRA & NAGAR HAVELI DAMAN & DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU & KASHMIR JHARKHAND KARNATAKA KERALA LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ORISSA PONDICHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL
12.	District where Loan is required	PORT BLAIR
13.	Bank Branch where Loan is required	PORT BLAIR,A & N ISLAND
	Branch Address	1ST FLOOR,BJP BHAVAN M.G RD,MIDDLE POINT
14.	Name of Proprietors/Partners/Directors of Company and their addresses:
Name of Proprietors / Partners / Directors Age Academic Qualification Residential Address Telephone No (Residence) Experience in the line of activity (Yrs)
15.	Activity
	Existing:
	Proposed :	(If a different acivity other than existing activity is proposed)
16.	Names of Associate Concerns and Nature of Association:
Name of Associate Concern Address of Associate Concern Presently Banking with Nature of Associate Concern Extent of Interest as a Prop/ Partner / Director / or Just Investor in Associate Concern Relationship with Officials of the Bank / Director of the Bank
17.	Credit Facilities (Existing) (Rs. in Lacs)
Type of Facilities Limit (in lacs) Outstanding as on Presently Banking with Security Lodged Rate of Interest Repayment Terms Current Account Cash Credit Term Loan LC/BG If Banking with this Bank, Customer ID to 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 indebited to any other Bank / Financial Institution  other than those mentioned in 17 above
18.	Credit Facilities (Proposed) (Rs. in Lacs)
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?  Cash Credit No Yes Term Loan No Yes LC/BG No Yes
19.	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 (if imported machine, provide break up of basic cost, freight, insurance and customs) Contribution being made by the promoters (Rs.) Loan Required(Rs.) No Yes
20.	Whether loan is to be covered under CGTMSE  NoYes
	Details of Collateral Security Offered, if any including third party Guarantee # (# As per RBI Guidelines banks are not to take collateral security for loans upto Rs. 10 Lakhs to MSME units)
Description Value (in Lacs) Ownership Detail
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 1 (Actual) Past Year 2 (Actual) Present Year (Estimate) Next Year (Projection) Net Sales Net Profit Capital (Net Worth in case of Companies)
22.	Status Regarding Statutory Obligations
Statutory Obligation Whether Complied with Remarks (Any details in Connection with the relevant Obligation) 1. Registration under Shops and Establishment Act Yes No NA 2. Registration under SSI (Provisional/Final) Yes No NA 3. Drug License Yes No NA 4.Latest Sales Tax Return Filed Yes No NA 5. Latest Income Tax Filed Yes No NA 6. Any other Statutory dues remaining outstanding Yes No NA
	Select Identity Proof :	1.Passport 2.PAN card 3.Voter’s Identity Card 4.Driving license 5.Job card issued by NREGA duly signed by an officer of the State Government(For Small Accounts) 6.The letter issued by UIDAI containing details of name, address and Aadhaar number 7.Identity card (subject to the bank’s satisfaction) 8.Letter from a recognized public authority or public servant verifying the identity and residence of the customer to the satisfaction of bank. 9.Government/Defence ID card 10.ID cards of reputed Public Sector employers 11.Pension Payment Orders issued to the retired employees by Central/State Government Departments, Public Sector Undertakings 12.Photo ID cards issued by Post Offices 13.Photo identity cards issued to bonafide students by a University, approved by the University Grants Commission (UGC) and/or an Institute approved by All India Council for Technical Education (AICTE). 14.Photo identity issued by any public authority having proper record of issuance of identity proof which is verifiable from records 15.Ex-Servicemen Card with photograph 16.Bar Council/Medical Association/ICAI/ICWAI/ICSI Card with photograph 17.Student Identity Card with photo issued by reputed colleges with validity during the course period. 18.Defense Dependent’s Card with photograph’ 19.Married woman identity proof with maiden name, if supported with a verified true copy of marriage certificate 20.Credit card with photo together with statement of such card, not more than three months old. 21.Registered Property document with photo identity 22.Arms License issued by State / Central Government of India. 23.Freedom fighter’s pass issued by Ministry of Home Affairs, Government of India with photograph of applicant. 24.Employee State Insurance Card (ESIC) with photograph supported by latest month’s pay slip.. 25.Talati / Patwari (a local govt. official) attestation by way of putting rubber stamp and signature. Gram Sarpanch / Mukhiya attestation by way of putting rubber stamp and signature (For Small Accounts)
	ID Proof No :
	Select Address Proof :	1.Ration Card 2.Electricity Bill 3.Telephone Bill 4.Bank account statement 5.Letter from employer (to the satisfaction of the Bank) 6.Letter from any recognized public authority (to the satisfaction of the Bank) 7.Credit Card Statement- not more than 3 months old 8.Income/Wealth Tax Assessment Order 9.Letter from Public Sector employer 10.Letter from any recognized public authority having proper and verifiable record of issuance of such certificates. 11.Voter ID Card (only if it contains the current address) 12.Pension Payment Orders issued to retired employees by Government Departments/Public Sector Undertakings, if they contain current address. 13.Copies of Registered Leave & License agreement/Sale Deed/Lease Agreement. 14.Certificate and also proof of residence, incorporating local address as well as permanent address, issued by the Hostel Warden of the University/Institute, where the student resides, duly countersigned by the Registrar/Principal/Dean of Student Welfare. Such accounts shall however, be required to be closed on completion of education/leaving the University/Institute provided the constituent does not give any other acceptable proof of residence to the Bank. 15.For students residing with relatives, address proof of relatives, along with their identity proof, can also be accepted provided declaration is given by the relative that the student is related to him/her and is staying with him/her. 16.In respect of officials of Central/State Governments and Public Sector undertakings, who are low risk customers for Bank, Branch Heads may verify the photo/identity and confirm residential address of such officials from independently verifiable sources, to their satisfaction, and permit opening of accounts. This facility is extended only to the Gazetted officers of Central/State Government and Senior Management and above functionaries of Public Sector Undertakings. 17.Latest telephone bills from any telephone service providers and mobile service providers not more than 2 month old, postpaid. 18.Consumer gas connection card/book/Pipe gas bill 19.Certificate from ward/equivalent rank officer, maintaining election roll certifying address of the applicant 20.Post Office Savings Pass Book 21.Domicile Certificate with communication address and photograph 22.Certificate by Village Extension Officer (VEO) / Village Head or equal or higher rank officer. Branch to confirm the authenticity of the certificate and that it has been issued by the person who is holding the said office. 23.Court divorce order – Marriage annulment order issued by Co
	Address Proof No :
	Enter Text Shown Below: