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8. PAN CARD NO
9. CONSTITUTATION
AGE ACADEMIC
QUALIFICATIONS
12. ACTIVITY
RESIDENTIAL
ADDRESS
TEL.
NO.
EXPERIENCE
:a)
Address Presently
Banking
with
Nature of
Association
Extent of Interest as a
Directors or just Investor
in Associates concern
14. Relationship of Proprietor with the Official Of The Bank/Directors of the Bank:
14(a) CREDIT FACILITIES (EXISTING)
Type of
Facility
Current A/C
Cash Credit
Limit in
Lacs
Outstanding as Purpose
on _______
Bank
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Bank of Baroda
Term Loan
LC/BG
If banking with this Bank, Customer No be given here:
14(b) It is certified that our unit has not availed any loan from any other Bank /
Financial Institution in the past and I am not indebted to any other Bank/Financial
Institution other than those mentioned on 10(a) above.
15. CREDIT FACILITIES (PROPOSED)
Type of
Facility
Amount
in Lacs
Purpose for
which
required
Security Offered
In Case of term loan requirements, the details of machinery may be given as under:
16. Details Of Collateral Security Offered, if any, including 3rd party guarantee:
Security Offered
Address
Valuation
Remark
Bank of Baroda
Latest Income tax return
filed
Any other statutory dues
remaining outstanding
16.
19.
SPACE FOR
PHOTO
SPACE FOR
PHOTO
SPACE FOR
PHOTO
Signature
Signature
Signature
Signature
Date:
Place:
I/We certify that all information furnished by me/us is true; that I/We have no borrowing
arrangement for the unit except as indicated in the application; that there is no
overdue/statutory dues against me/us/promoters except as indicated in the application;
that no legal action has been/is being taken against me/us/promoters; that I/We shall
furnish all other information that may be required by you in connection with me/our
application that this may also be exchanged by you with any agency you may deemed fit
and you, your representative, representative of the Reserve Bank of India or any other
agency as authorized by you, may, at any time, inspect/verify my/our assets, books of
account etc. in our factory /business premises as given above.
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