Application form for Loans above Rs 50,000
Name of the Bank State Bank of India
LOAN APPLICATION FORM PRADHAN MANTRI MUDRA YOJANA
( To be submitted along with documents as per the check list )
A. For officeUse:
EnterpriseName Application Sl. No. Name of the Branch Category
RAHUL MODANWAL SATE BANK OF INDIA Tarun
B. Business Information:
Name of the RAHUL MODANWAL
Enterprise
Constitution √ Proprietary √ Partnership Pvt. Ltd. Ltd. Company Any Others (specify)
JAGGANNATTHPURI, KERAKATPUR, LOHTA,
Current
Business
State U.P. PIN Code 2 2 1 1 0 7
Address
Business Premises √ Rented Owned
Telephone No. Mobile No. 91
E-mail:
Business Existing EXISTING
Activity (To run business of Sweets & Restaurant.)
Proposed
Date of Commencement(DD/MM/YYYY)
Whether the Unit is Registered √ Yes No
If Registered (Please mention:Registration
no. And the Act under which registered )
Registered office Address
Social Category SC ST OBC √ Minority Community
IfMinority
Buddhists Muslims Christians Sikhs Jains Zoroastrians
Community
C. Background Information of Proprietor/ Partners/Directors:
S.No Name Date of Sex Residential Academic Experience in
Birth Address with Qualification the line of
MobileNo. activity (Years)
1. RAHUL 04/08/1995 MALE JAGGANNATTHPU 2 Years
MODANWAL RI, KERAKATPUR,
LOHTA, VARANASI,
U.P-221107.
S.No Id proof Id proof no. Address Address proof PAN Relationship with the
proof no. Card/DIN No. officials/ Director of the
bank if any
1. Pan Card DLXPM9524E Aadhar Card 766541487736 DLXPM9524E
2.
D. Names of Associate Concerns and Nature ofAssociation:
Names of Address of Presently Nature of Extent of Interest as a
Associate Associate Banking with Association Prop./Partner/ Director or Just
Concern Concern Concern Investor in Associate Concern
N.A
E. Banking/Credit Facilities Existing: (InRs.)
Type of Presently Limit Outstanding Security Asset
Facilities Banking with Availed As on …… lodged classification
status
Savings Account N. A. N. A.
Current Account N. A. N. A.
Cash Credit
Term Loan
LC/BG
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/we am/are not indebted to any other Bank / Financial Institution other than those
mentioned in column no. Eabove.
F. Credit Facilities Proposed:(InRs.)
Type of Facilities Amount Purpose for which Details of Primary Security Offered
Required (with approx. value to be mentioned)
Cash Credit 2.00 Lacs To meet W/C Hypothecation of stock, book debt, furniture
requirement & fixture and other current assets both present
and future.
Term Loan
LC/BG
Total 2.00 lacs
G. In case of Working Capital: Basis of CashCredit Limit applied:(InRs. 2.00 lacs)
Actual Sales Projected
FY- FY- Sales Working Inventory Debtors Creditors Promoter’s Limits
Estimat Cycle in Contribution
ed Months
Year
2019-
20
15.15 3.79 Lacs 3.50Lacs 0.26 2.00 Lacs
H. In case of Term loan requirements, the details of machinery/equipment may be given as under:
Type of Purpose Name of Total Cost of Contribution being Loan Required
machine for which Supplier Machine made by the (Rs.)
/ Equipment required promoters(Rs.)
Total
Repayment period with Moratorium period requested for
I. Past Performance / Future Estimates: (InRs.)
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)
Present Year-I Present Year Next Year (Projection) Next Year (Projection)
(Estimate2019-20) 2021-22 2022-23
Net Sales 15.50 18.18 22.00
Net Profit 1.25 1.51 1.84
Capital (Net 6.64 7.34 10.72
Worth in case of
Companies)
J. Status Regarding StatutoryObligations:
Whether Remarks
Complied with (Any details in
Statutory Obligations (select Yes/No) connection withthe
If not applicable relevant obligation to be
then select N. A. given )
1. Registration under Shops and Establishment Act
2. Registration under MSME (Provisional /Final)
3. Drug License
4. Latest Sales Tax Return Filed Yes
5.Latest Income Tax Returns Filed Yes
6.Any other Statutory dues remaining outstanding
K. Declaration:
I/We hereby certify that all information furnished by me/us is true, correct and complete. I/We have no
borrowing arrangements for the unit except as indicated in the application form. There is/are no
overdue / statutory dueowed by me/us. I/We shall furnish all other information that may be required by
Bank in connection with my/our application. The information may also be exchanged by you with any
agency you may deem fit. You, your representatives or Reserve Bank of India or Mudra Ltd., or any
other agency as authorized by you, may at any time, inspect/ verify my/our assets, books of accounts
etc. in our factory/business premises as given above. You may take appropriate safeguards/action for
recovery of bank’sdues.
Space for Photo Space for Photo Space for Photo
(Signatures of Proprietor/partner/ director whose photo is affixed above)
Date:_
Place:_VARANASI
CHECK LIST: (The check list is only indicative and not exhaustive and depending upon the
local requirements at different places addition could be made as per necessity)
1) Proof of identity - Self certified copy of Voter’s ID card / Driving License / PAN Card /
AadharCard/Passport.
2) Proof of Residence - Recent telephone bill, electricity bill, property tax receipt (not older than 2
months), Voter’s ID card, Aadhar Card & Passport ofProprietor/Partners/Directors.
3) Proof ofSC/ST/OBC/Minority.
4) Proof of Identity/Address of the Business Enterprise -Copies of relevant licenses/registration
certificates/other documents pertaining to the ownership, identity and address of businessunit.
5) Applicant should not be defaulter in any Bank/Financialinstitution.
6) Statement of accounts (for the last six months), from the existing banker,if any.
7) Last two years balance sheets of the units along with income tax/sales tax return etc.
(Applicable for all cases from Rs.2 Lacsandabove).
8) Projected balance sheets for one year in case of working capital limits and for the period of the
loan in case of term loan (Applicable for all cases from Rs.2Lacsand above).
9) Salesachievedduringthecurrentfinancialyearuptothedateofsubmissionofapplication.
10) Projectreport(fortheproposedproject)containingdetailsoftechnical&economicviability.
11) Memorandumandarticlesofassociationofthecompany/PartnershipDeedofPartnersetc.
12) In absence of third party guarantee, Asset & Liability statement from the borrower including
Directors& Partners may be sought to know thenet-worth.
13) Photos (two copies) of Proprietor/ Partners/Directors.
Acknowledgement Slip for loan Application under PradhanMantri MUDRA Yojana
Office Copy:
Application (system Date of Application
generated/manual) Number
Name of the Applicant(s) RAHUL MODANWAL Loan Amt. Requested for 2.00 Lakh
Signature of Applicant(s) Signature of Branch
official
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Acknowledgement Slip for loan Application under PradhanMantri MUDRA Yojana
Applicants Copy:
Application (system Date of Application
generated/manual) Number
Name of the Applicant(s) RAHUL MODANWAL Loan Amt. Requested for 2.00 Lakh
Signature of Applicant(s) Signature of Branch
official
