# Colored input boxes with symbol accepts only numeric values

1. Name of the Enterprise *:    
2. Registered Office Address:
3. Address of Factory/Shop
4. Category
5. Telephone No. #
6. Email Address*:
7. Mobile No.* #
8. PAN Card No.*
9. Constitution :
10. Date of Establishment*:     DD MM YYYY
11. State :
12. District where Loan is required
13. Bank Branch where Loan is required
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
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
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
Term Loan
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.)

20. Whether loan is to be covered under CGTMSE 
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
2. Registration under SSI (Provisional/Final)
3. Drug License
4.Latest Sales Tax Return Filed
5. Latest Income Tax Filed
6. Any other Statutory dues remaining outstanding
Select Identity Proof :
ID Proof No :
Select Address Proof :
Address Proof No :
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