Form:A

Application form for applying loan under Angel Fund Scheme

A passport size photograph

pest here

1.Name & Address of the applicant : ......

2.Office Operating Address------

3.Address of Factory/Shop------

4.Whether Belongs to SC/ST/OBC/Minority Community: Yes / No

If Yes, then Please Select: SC/ ST/ OBC/ Minority Community

and attach the certificate from the competent authority.

5.Mobile No. ______

6.PAN Card No. (if applicable) ______

7.Place where loan is required------District------Block------

8.Branch where loan is required ------

9.Name of the Promoter

Name / Residential address / Date of Birth / Father/Spouse / Academic Qualification / Contact No.

10.Details of the scheme/activity ______

  1. Name of the activity/Scheme and purpose-----
  2. Approximate value of the proposed scheme/project----

11.Whether undergone any skill development training under Industry Department/DI&CC/Other Govt. Department/Organization/any other experience and training undergone------Yes / No

If yes, please attach the copy of the certificate/document.

12.In case of term loan requirements, the details of machinery (Wherever applicable) may be given as under ( for new unit):

Type of
Machine/
Equipment / Purpose for which Required / Whether
Imported
or
Indigenous / Name of Supplier / Total Cost of Machine / Contribution being made by the promoters / Loan
Required
  1. Address and Identity proof :-A

a.)ID Proof (Any of the following): -

Voter Identity Card/ PAN Card/ Driving Licence/ Job Card/ Aadhaar Card/

Identity Card (subject to the satisfaction of bank)

ID Proof No. ______

b.) Address Proof (Any of following): -

Electricity Bill/ Telephone Bill/ Bank Account Statement of any other bank/ Letter from reputed employer/ Letter from recognized public authority verifying the address of the customer to the satisfaction of the bank/ Ration Card .

Address Proof No:- (Consumer account No./License No./Card No.etc)

Additional information for existing unit

  1. License/ Registration if any:-

( Select Yes /No). If not applicable then select N. A.
1. Trade license / Yes/ No/ NA
2. DICC Registration certificate (Provisional /Final) / Yes/ No/ NA
  1. Banking /Credit Facilities for existing unit ( in Rs.lac)

Type of facilities / Limit(in lac) / Outstanding as on / Presently banking with / Securities / Rate of Interest / Repayment terms
Current Account
Cash Credit
Term Loan
  1. Past Performance / Future Estimates ( for existing unit) :-

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)
Rs. in lakh / Past Year 1 (Actual) / Past Year 2 (Actual) / Present Year (Estimate) / Next Year (Projection)
Net Sales
Net Profit

Declaration:

I do hereby certify that all information furnished by me is true that I have no borrowing arrangements for the unit except is in the application that there is no over dues/ statutory dues against me except as indicated in the application that I shall furnish all other information that may be required in connection with my application that this may also be exchanged by you with an agency you may deem fit and you, your representatives or Govt. Official from Industries & Commerce Department /DICC’s or Reserve Bank of India or any other agency as authorized by you, may at any time, inspect/ verify my assessment of account etc. in my factory/business premises as given above.

Date:-

Place :- Signature of the applicant