Company Information
Name of the applicant
Business Address
Factory Address
Legal Status
Date of Commencement
Of Business
Line of Businesses
Purpose of the loan / o Corporate Office o Factory Building o Construction of Apartment
o Others
Present status of Office building / Factory / o Own o Rented o Others o Not Applicable
Rent Amount (If rented) / TK.
Ownership Information
Name of the Managing Director/Proprietor
Name of the Chairman
No of Directors/Partners
Directors/Partners/Proprietor Particulars
Name of the Directors / Shareholding % / Present Address / Permanent Address
Monthly Income Information (in Taka)
Monthly Revenue
Other Income:
i)
ii)
iii)
Total Income
Monthly Expenses
Other Expenses
Total Expenses
Loan Information
Purpose of the loan
Loan Amount / TK.
Term / Years ______
Details of the project to be constructed
Property -1
Developer' Name:
Project Name:
Address of the Project:
Details of the Project
Type of Land / o Private / o leasehold
Apartment No. / Floor(s) No.
Apartment Size ______/ sft.
No. of Car Park(s) ______
Land Area :
Market Value:
Details of Property to be provided as Security
Property -1 / Property -2
Developer' Name: / Developer' Name:
Project Name: / Project Name:
Address of the Project: / Address of the Project:
Type of Land / o Private / o leasehold / Type of land o Private o Leasehold
Apartment No. / Floor(s) No. / Apartment No. Floor(s) No.
Apartment Size ______/ sft. / Apartment Size ______sft
No. of Car Park(s) ______/ No. of Car Park(s) ______
Market Value / Market value
Financial Plan
Fund Requirement / Source of Fund
a) Purchase Price/Construction cost / a) Amount Already Spent/Paid
b) Registration Cost / b) loan Requested
c) Others Cost / c) Source of Balance fund
i. / i. Savings in Bank
ii. / ii. Disposal of land / FOR
iii. / iii. loan from Employer
iv. / iv. Others Source
Total Fund Required: / Total Fund Planning:
Details of Assets (in Taka)
Savings in Bank
Sanchay Patra
FDR
Life Insurance Policy
Wage Earner Bond
Others (if any)
Immovable Property
(Land/Building/Flat/Others )
i.
ii.
iii.
Details of Borrowings and Liabilities (as of ………………………………..)
Types of Loan / Lender / Sanctioned Amount / Loan Term / Monthly Installment / Outstanding Amount / Expiry
Have the company or any of its sister concern given guarantee (s) for any borrower(s)? o Yes o No
If Yes, Loan A/C No: Name of Borrower:
Loan Amount: Name of the Lender:
Date of Expiry:
Bank Account Details
Name of Account Holder / Name of Bank / Branch / Account Type / Account No.

Declaration:

I/we declare that all the particulars and information given in the application form are true, correct and complete and shall form the basis of any loan to CAPM Venture Capital and Finance Limited (CVCFL) may decide to grant to me/us. I/we further confirm that I/we have/had no insolvency proceedings against me/us nor have adjudicated insolvent. I/we agree that CVCFL may take up such references and make such inquiries in respect of this application, as it may deem necessary. I/we have undertaken to inform CVCFL regarding any change in my/our occupation/employment and to provide any further information that & CVCFL may require. I/we further agree that my/our loan shall be governed by rules of the CVCFL, which may be in force in time to time.

______

Authorized Signature Authorized Signature

Date: Date:

Please tick the items you are submitting along with the application

Company
1. Passport size photograph of proprietor, partners, directors (as applicable)
2. Profile of the Company, Including Directors profile, statement of business, details of products/clients etc.
3. Documentary evidence (e.g. Trade license, partnership deed, MEMART as applicable)
4. E-TIN Certificate for all Directors.
5. Audited Financial Statement like Income Statement, balance sheet, Cash Flow Statement and Statement of Owners equity for last 3 years.
6. Bank Statement of the business for last one year
7. Bio-Data and Passport size photograph of proprietor, partners, directors as applicable.
8. If the company has any other income, proof of the income
9. Rental agreement (If any)
10. Up to date statement of loan, Sales, Net Income, Asset, Liability, Net worth of the company and other companies of the group or borrower , if any
11. Documentary evidence in support of assets & other savings, if any
12. CIB information & undertaking
13. National ID Card and ETIN Certificate of the directors.
14. Net Worth Statement of all of the Directors
A. For Private Land / B. For Leasehold Land
1. Copy of Ownership deed
2. Baya deed (original/certified/photocopy)
3. Recent survey report (i.e. Math parcha duly attested)
4. CS/RS/SA & mutation khatian with DCR
5. Up to date khajna & municipal tax receipt
6. Up to date Non Encumbrance Certificate.
7. Approved plan and approval letter of Rajuk/CDA
8. Detailed Estimate of the cost of construction
9. Development agreement with the land owner & registered Power of Attorney
10. RJSC certified MEMART of the developer
11.Developer’s Board Resolution for execution of documents / 1. Ownership deed/lease deed.
2. Baya deed (original/certified/photocopy)
3. Development agreement with land owner(s)
4. Registered Power of Attorney (if any from land owner(s))
5. Mutation Khatian from relevant govt. office
6. Recent survey report (i.e. Math parcha/city jarip duly attested)
7. Up to date Non Encumbrance Certificate.
8. Up to date land tax receipt & municipal tax receipt.
9. Permission from the lessor to mortgage (if required)
10. Approved plan and approval letter of Rajuk Authority.
11. Detailed Estimate of the cost of construction prepared
by a qualified Eng. at current market rate. (In case of
self construction)
Director/Proprietor Particulars (to be filled for each of the Directors)
A. Name
B. Father's Name
C. Mother's Name
D. Husband's Name
E. Wife's Name
F. Date of Birth / G. / Marital Status / 1. Married / 2. Unmarried
H. Residence Address
I. Permanent Address
J. Academic Background
Year / Name of Institution / Div./Class
1. Secondary Level
2. Higher Secondary
3. Bachelor
4. Masters
K. Business Background/Experience
L. Other Qualification/Affiliation
M. TIN No.
N. Passport No.
Signature
Name:
Applicant’s/Director’s Net worth Statement
(To be filled for each of the Directors)
1. Name:
2. Address:
3. Properties & Assets
A. Land
Area:
Location:
Market Value: / Encumbrance (If Any):
B. Building
Location:
Covered Area: / Year Built:
Market Value:
Encumbrance (If Any):
C. Investment Detail:
D. Cash & Bank Balance:
E. Other Assets:
Total (A+B+C+D+E):
4. Liabilities
A. Bank Borrowing
Name & Address of the Bank:
Amount of Loan: / Nature of Loan:
Outstanding as on ………..:
Securities against loan:
B. Other Liabilities:
Total (A+B):
5. Net Worth (Total Assets-Total Liabilities):
Signature
Name:
Information about the Sister Concerns
Please forward the information as of ……………………..
(Figures in '000 TAKA)
Total / Current / Long Term / Current
Name of the Concern / Total Sales / Net Profit / Assets / Assets / Liabilities / Liabilities

UNDERTATKING

(To be filled by each Director) Annexure “Ka”

Date ______

Manager

CAPM Venture Capital Finance Limited (CVCFL)

Principal Branch

Grand Grandeur Tower (Level 07)

Kamal Ataturk Avenue, Banani, Dhaka 1213

Subject: Information relating ownership of borrower organization/individual

Dear Sir,

I, ______Proprietor/Partner/Director of ______

Father’s Name :

Mother’s Name :

Spouse Name :

Permanent Address :

Present Address :

Business Address :

am applying in my own name/in the name of an organization under my ownership for sanction/ renewal /rescheduling of credit facility.

In addition to the organization mentioned above, I enclose herewith a list of business organizations in my own name/under my ownership/under my management and control. If any business organization other than as mentioned below is found in my own name/under my ownership/under my management and control, I shall be accountable and punishable for false statement and misrepresentation. The authority can take any legal action against me for suppressing facts and I shall be obliged to accept any such decision.

Sl No / Name of Enterprise / Permanent Address / Business Address / If the enterprise is enjoying any credit facility
Yes / No
Name of the Bank/FI / Name of Branch

Please attach separate sheet, if required.

I shall notify any change in the above-mentioned information within 14 days of the change, in failure of which the Authority can take any legal action against me.

Signature :

Name :

Name of Borrowing :

Enterprise :

CIM (Appendices)- REF,Company: CRM, CVCFL Page 5