APPLICATION FORM UNDER BYST- BANK OF BARODA EDP Convenient Bank of Baroda Branch: (This should be ensured during

site verification by the person in-charge) 1 2 Name of Unit Present Address (Business) Telephone No Proposed Address (Business) Present activity Proposed activity Date of establishment Constitution (Proprietorship / Partnership / Others) Name of Proprietor Date of Birth/ Age Qualification Experience Whether SC/ST/MC Present address (Residence)

3 4 5 6 7 8

10

Statutory Certificates held. SSI regn. No. PAN TIN /TNGST/CST

Others 12 Present Banker & Branch

Brief background of the promoter/s with past experiences:

Past performance (Last 2 yrs financial statements attach if available): Not applicable During the year (Current year financial statement attach if available): Not applicable (In lakhs) Particulars Turnover Raw materials purchases Other expenses / Profit Infra-structure available: Business premises Area Leased / Owned Lease rental per month Advance money paid Power Existing 25 HP as per the lease agreement For proposed Same as above No of employees: Existing Proposed List & details of existing machinery and other assets Previous years Last year Current year A detailed analysis is enclosed to this application.

Names of Major customers Details of orders on hand

Various clients - details enclosed. The unit regularly supplies the food artciles in a packed plastic bag.

Present Request: Cost of Project Rs

Total Sources of Finance Promoter's contribution @15% Loan from Bank- TL Total Sources of margin money (Specify): Own source Other details Source of funds Repayment p.m. Present O/s Amount of default Rs

The repayment schedule is enclosed to this application Cost of production and profitability statements for the period of repayment: (In Lakhs) Particulars Turnover Raw materials Other expenses / Year 1 Year 2 Year 3 Year 4 Year 5

Detailed projections and assumptions are enclosed to this application

Affix recent PP size photo

Affix recent PP size photo

Signature of the first applicant

Enclosures: (1)SSI Registration Certificate (2)PAN / TIN / TNGST /CST (3)Partnership deed (4)Proof of residence (5)Proof of Identity (6)Statement of accounts with present banker (7)Financial statements & IT assessment copies (8)Proof of Date of Birth (9)Lease deed / Rental agreement (10)Quotations for machinery & other assets to be purchased (11)Photograph (12)Assets & liability statements of the applicant (13) Mentor charges letter (14)Copies of orders on hand (15)Site verification form (16)Technical Evaluation form (17)Profitability statement (18)Repayment schedule

YES NOT APPLICABLE NOT APPLICABLE YES YES YES NOT APPLICABLE YES YES YES YES YES YES YES YES YES YES YES