fxkMq

1t;
Sy*dlq$eB,gnfi
rririi,erirrirsri,,

affii / Trffi / f,TM I va EreffirETFt'q} I rcqrUFcr<r:neit fr sTrffi s#r cr..Krcfa * dt

Particulars of Assets & Liabilities of the individual / Partners / Directors / Co-obligants / Gr*;*r*x"l*ns
xur eTr+qfr q* t qrq {iflT fdiqr qrq / To be accompanied with Loan Apptication}

o la; wd sI TI-q d?II gs / Name of the Party and Age ,.luue xl^4b R*
s b) qror z ftm z cff, fiT flq nqT Bs'
Mother's I lally>ris / Husband's Name and Age Q^'nvri [s h R^;

{ c) ryfr 61ilq iw gs i Name and Age of Children Sulha^Qor',A 2o

s d) {dffiqffi / PresentAddress vitl- kh''iuo Nluba |.s" j
"rm
g e) en* q-or / Permanent Address v;11- pait. Mr"rha"noa 27d 3a?
q f) qE$rq I Occupation ricuffuris
kfiur / Particulars
tfr{iqg /TelephoneNo.
qf4'rEm S. / Mobile No. ?e 9s619i-46 I QaoQolsL6+
i-t-d qIfS / E-mait tD

1. Erar{rq fr f;rsi&rd {q1 f=Tfr qd'q s{fqm. a.rif{rt t eTfdftffi rrx qitrrc * ai) I Capitai eryi!}iir,.,iir:
Business (lf more than one business, attaeh additional sheets)
1.1 .F{ sr tfrl 1F{ /'Name(s) of Frrm N/r R4r s-D poury FaRr
1"2 mC *r]Tf{ / Constltution of Firm zo\fol - %t4
1.3 qd il- SlE qidq ; Retarionship with Firm g,on'.vf bi

1.4 f{rirffr'( {S i Capital emptoyect

J

1.5 e-dqm dA{ / Exisring Bankers uNrrN BAxr oF E^tDz4(Semcrla, ?oE

1.6 *ml- dl qq l:tM c4 r E-T--r (cr flos i)
I Liabitity ro Banks
1.7 qflnfm e{rc I Annual lncome

lEi?rt riqfi I Heat Estate trrfitt / Charged *m rfta I Li**$rr.g*d

2.1 fiqFi et <fOq' / Nalure of property

z.z fuekffiffi{q+1s .. . e-fl-0€

t 6s
The Deed and Sale Deed No. and Date: h4*X, _

enq ofu sff {@r / Location & Survey No. !r"- - [h".ir^ lyloh -4P,
Trcffl q] ffi s {iEiftril E.diu
Details of the boundaries of Prooerty P"tr^n^. t'lbni
srdrd;r s{ {Sq *t ckf dfrrr +1qrq k\^*" No - (lo)??
Copy of latesi Tax pirl receipt to be enciosed
pLol{a- !6S
+.I,Ff,, q.f ga i i Extent in sq. Ft. q,_y_9 h..t
?
2.4 Wf {S-rfr-€
qT q€FId / Freehold or Leasehoto
r-f

2.6 q$qq qqq og +t€ d I Existing Liability if any Nl ru

z.z qrffi{ eilq / Annual lncome

3. $izn I fu:frt / qqF{FT rig / Shares / Debentures / Mutual Funds

3.1 f{*crrTr q-ilTFfr sT crq efu {qt
Name of the Depository participant and number

3.2 r{-ffi sr flq (qs-f, at €gffi)

Name of the holders (Single or Joint)

qre+ en{.S. S.fr.3{r{.S. / Client lD DPID

3.3
NTL
s.4 S.fr. tqqercknkflurSf,,lf5qlqq I

qf$R
T3{ (SeIl I Latest statement from DP to be

enclosed. Market Value (Total)

3.s {dqr iqnr, ffi q{ +t$ d I Existing Liability

pledge if any

qrffi+ efq / Annual lncome

3.6
4. Trmrfr sftrslfrqf (qR ffi urq filflur {?tr{ faqt qrql
w fr t d, *.fr. *
Govt. Securities (lf in demat form statement from DP to be enclosed)

4.1 qRr$l4f ST g€q / Nature of Securities

4"2 siftr( qrl. / Face Vaiue

4.3 kRTe€@r( i Distinctive Nos.

4.4 qfu:te+t'r 3fiR{ 3+r tntE, I

Maturity Period and Date
\ Nrr

4.5 qgg-euor{fl- / Maturity Value \

4.6 t mT{, qE dr{ d / tiunititi"u, if any
4.7 qrfilmarq /Annual lncome
5. frfi fic / srm ftcr ftff,fu (erercc(Copy
frFrirc *Rs I Tfrq a1 rfr {?Fq a1 *rql
latest premium notice/receipt to be enclosed)
Life / Postal lnsurance Policies of

5.1 qlqT +tl-fr lrfl! q1fl-it / Name of the lnsurance

Company Division

5.2 ,itkfu {qf Poticy No.

5.3 mqrt( {s-q / Amount Assured

5.4 qrfdR q.,1ffifl=e, ++r

Date and Period of PolicY
q-qFi /
\ Nru
s.s flr ErkR qrqt I whether the Policy is in force
5.6 ,rfi {eT / Paid-up Value
 I-

fi-q5, erg.fr. Sq;

q-qft al qf{qt {qq +1orq I copy of invoice, RC book etc' to be enclosed

l{rFR qR {Fd / UnCharged

6. cVffi / Er6{ / Machinery / Vehicles / Charged

6.1 qr+a ti-+) e*t'*e-f, / Make and Model

6.2 q-q-{rrr {wt / Reg. trto.

6.3 c-{W W +18rf, / Original Price Paid

XL
6.4 Hr Wi-dql dq6 t / Whether Fully lnsured \f
6.5 4qlq{sTqirs-t,Tqt I WhetherTaxes Paid

6.6 q-f,qnCffwq / Present Market Value

6.7 ffi, cR +ti tt r Liabitities, if any

I 7 Errtr{[FFli / Deposits _

7.1 +s. 4qfr ml {F{ / Name of the Bank / Company

7.2 qq-{rR-r sl q{q / Nature of Deposit

2.3 sql-{rRrft1 {i@l/ Number of Deposit

7.4 qqRrRT d r+q / Amount of Deposit

7.5 qqrmlfiffiftq / Date oi Deposit
7.6 qft{flf,rft1fftq / Maturity Date

7.7 qftTfl{r Tfq / Maturity Value

7.8 W, qR +ti dt I Liabilities, if anv

7.9 qffi ef+ / Annual lncome

I
8. fri fr trdf 3ft sTrqqur / Gold Ornaments and Jewellery
8.1 EISR {fl / Market Value \
-No
a.2 N, qfs +t{ d I Liabilities, if any

9. 3i-q sTrflwqi q ttl-(t[( / other Assets & Liabilities

9.1 erq sTrkd (s?*q 6.t) / other Assets (speci{v) Ar ttgLt- R"*4' $o fl*1
lu
4.la)
]inxr,,;a,l ff Re,.rl Jn* y
flns[ibh,,
s/b)

Tic)
-$l.r" t+* al, <0ro 6d;fi*T-

9.2 srqtq-dr( (sdq*t;l Otner Liabilities (Specifv)

qri)
 4

ry_iryr1l qT*fl2
0.,i sqielrtqo/ ftkm z.ntffiu qRthfsr.gdrifaRrsErW/ gFqqiffintoirWt*s.u fi.f im+ai{j
ensq +1 {$ €1 r / Whether any legal action/litigation is pending against applicanti partnerldirector/ guarantor/surety
which have been initiated by another bani</financiet. NO
- ' .
---
10. ^-s--;-
lTs.irJ + adr tqFn {if,*{ sl qK) / Details of passport -
(Copy to be enclosed)

il. qqT qrqm{/ {icfrs{Fruftrdtz tqntifr

erdc;{ s-{ ffik"r o{Tt{r qft qfdqf {mq 6t)
Whether lncome tax/Wealth lax assessed? (if so \r--Es
enclose copies of lAtest'dssessment order) I
12. srge+ qoi t{} a+fqq;oq *a+rfr 3fu fdrdTq h qer *rs efu v& t I eni fr q-q+ trrr I *fr (B tq uffi sr 3ihq
frqtFid,tcffi+.,qa1lf,fudsEqfA/arjqF(;em+ifrskrsc,fqn'iidf,HIar;q rimfto/ qRq-rnr&6fIT 7qffi I 45oru
information is true and correct to the best cf my knowledge and belief. Furlher, I undertake not to alienate/ encumber
the propedies noted above without the knowledgei consent in writing of the Bank till the final settlement of the dues.

Rill / Place :
h b;r; --\IPf {rr
qi*flr Fkr+&esirt
ctrikq / Daie :
9*-o8-z,lg /
/ Director
Signature of Applicant / Partner

t{EdTtE-drqr0 / $tffi z qrg+d ftfris ?iqfr q$qK s frt{r{, ani q{T qiq)
*
(To be filled by Co-obligant / Guarantor /Partner & Director of the Private Limited Co.)

fe€l qt riw +i itH qRfr f+ffi * *'ur gftqr3tr s imq

(e{ff{s sr cTq

{uqg{*-q.tT.n6,,,qif*TisIqrk-€frqi+fdq+stt{t/lamwillingtostanriasaCo-obligant/Guarantortoany

t,Hfr-{fi ei qlal )
(Name oi Ap6:!icant)
i.r-{H I place :
,IrSg i Date :

sddTrqffirrs / qT*qif,f t em'rtn

Signature o{ the Co-Obligant i Guarantor

*a / Note ' r. gTr+qm,qtfu+i, qEaz ff,ft}s iirrfi & fiMi, e-dffiq-dftfiftri, rnrMeir gru
{ffi - sif,{ qc{ t{{ 3rt{
HflqRil f+q qR I Separate format has to be filled and signed by Applicant, Proprietors, Directors of Pvt.

Ltcj. Co., Co-Obligants and Guarantors.

2. qE{ {3.3{q{zrm d 3tfdR-ff wFF sT c4{ fuqT Srq I / Use additional sheets wherever necessary.

VriTglsii*gq*Ir[{ / USE AT THE BRANCHES

*ql-{qi all,iIqfi'.
qi{r cq( {cfr=if si{ tq-dTsii + qtn sr sdrr{ ffiqr t efu C r Eq es+1qqt-f,szr-frl fr1gE fl-{f,r t/ s{-ft t I scgs{
qlTqil-fr b siitm qi qt-S +1 qTfi{qf etr{ aq-flq iln
EA
qrfil{d ftq-d(t I / I / we nave verif ied rhe parricutars oi Assets &
Liabiiities furnished by sri/Smr. "..s.v.r:.n{r*..N*tb .R6i
and confirm its correctness. Based on the above information the Assets & Liabilities and Networth of the Party are
as under
1) /rorALASSErs 7y" +t L^k\r
3ffi qrk-si
z) M / TorAL LtABtLtIES ?
-f-d

S1a) q-.q'q1tzrclr( / Direct Liabilities : \

+IeT 3?-il-{ / Other Borrowing \

{qib) q0sr EqnTq / lndirect Liabilities : \
c-xanzranrrfi rrnrffi & w fr / as co-oht /Grrarantor Ntt