F. No.

117A BANK OF BARODA (HEAD OFFICE : MANDI, BARODA) REPORT ON THE MEANS AND STANDING OF THE BORROWERS/GUARANTORS/SURETIES NAME OF THE BORROWAL A/C. 1 Name in full 2 Age 3 Father's / Husband's Name 4 Residential Address (Permanent) Residential Address (Present) 5 Telephone Numbers : office / Shop ::::::- Residence :Office/Shop::-

6 Occupation / Line of business (A) If in service : Name of Employer & Address Designation (B) If in business / profession ( i ) Name of the firm / Company and its address :

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( iii ) Since when established : ( iii ) In which capacity he / she is representating 7 Annual Income Rs: 8 Value of Total Assets (As per details overleaf) 9 Details of loans taken in individual/Firm's/Company's Name a) Name/s of the Bank/other institution and its branch b) Purpose and amount of loans availed Rate of interest c) Present outstanding balance d) Security & Repayment schedule e) Other details 10 Total liabilities 11 Net means (7 - 9) 12 Details of guarantees given Name of the Institution to whom guarantee is given Name of the person/concern on whose behalf guarantee is given

::::-Rs.

::-Rs.

:-Rs. :-Rs. ::-Rs. :-Rs. :Amount of guarantee given

13 Remarks, if any

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Date :JT. MANAGER PARTICULARS OF MOVABLE PROPERTY OF MR. / MRS. / MISS.

BRANCH MANAGER

LIFE INSURANCE POLICIES Policy No.

Date of issuance of policy

Sum Assured Rs.

Amount of Premium Total Amt. Premium paid upto of premium paid in a yr what period paid

INVESTMENT IN GOVERNMENT SECURITIES LIKE BONDS / NSC PPF & MUTUAL FUNDS Bond / Certificate No. Date of Name of Amount Due Maturity Purchase Post office / Rs. Date Value M.F. Rs.

TERM DEPOSIT / SHARES / DEBENTURES ETC. Name of Bank & Branch Date of FDR/Share/ Total Amt. Due Date Latest Mkt. Purchase/ Debentures of FDR/ & Maturity Issue Certificate No. Debentures Value of FDR

OTHER ASSETS a) Jewellery b) Vechicles c) Capital Invested in Business d) Any other movable assets (please specify) ::::-

DETAILS OF IMMOVABLE PROPERTY i) Particulars of the property a) Type of Property b) Location c) Survey / House No. d) Area / Loacality Village, Town, District ii) Property standing in the Name of iii) Share of Applicant in the property iv) Whether encumbered / unencumbered partially encumbered (give details viz. with whom, consideration and major terms & conditions) v) Value of Property a) Cost (original + Value added) b) Present estimated market value ::::::::::-

TOTAL OF ALL ASSETS

Date :-

JT. MANAGER

BRANCH MANAGER