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Bank of Baroda

FORM FOR SMEs


(FOR OFFICE USE)

1.
2.
3.
4.
5.
6.
7.

NAME OF THE ENTERPRISES


REGD. OFFICE ADDRESS
TEL. NO
MOBILE NO
EMAIL
ADDRESS OF FACT
WHETHER BELONG TO SC/ST

: M\s
:
:
:
:
:

8. PAN CARD NO

9. CONSTITUTATION

10. DATE OF ESTABLISHMENT

11. NAME OF PROPRIETOR AND ADDRESS:


NAME

AGE ACADEMIC
QUALIFICATIONS

12. ACTIVITY

RESIDENTIAL
ADDRESS

TEL.
NO.

EXPERIENCE

:a)

13. NAME OF ASSOCATES CONCERNS AND NATURE OF ASSOCIATION


Name of
Associates
Concern

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

17. PAST PERFORMANCE / FUTURE ESTIMATE (Actual performance for 2 previous


year, estimates for current year and projections for next year to be provided for
working capital facility. However for term loan facilities projection to be provided till
proposed year of repayment of loan)
(Rs. In Lacs)
PAST YEAR PAST YEAR
PRESENT
NEXT YEAR
II
I
YEAR
(Projection)
(Actual) 2010 (Actual) 2011 (Estimate)2012
2013

18. Status Regarding Statutory Obligations:


Statutory Obligations

Whether complied with


(Yes/No)

Remark

Registration under shop


and Establishment Act
Registration under SSI
Drug License
Latest Sales tax return filed
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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

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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