STATE BANK OF INDIA:

MANUFACTURING
ANNEXURE-A - For MSEs upto 25 Lakh !App"#$at#o% &or'(
ANNEXURE-B - For Oth)rs A'ou%t *#s) !App"#$at#o% &or'(
TRADE AND SERVICES
ANNEXURE-+ - For MSEs upto 25 Lakh !App"#$at#o% &or'(
ANNEXURE-D - ,)%)ra" Information (Application form)
NAME Age
Academic
Qualification
RESIDENTIAL
ADDRESS
TELEPHONE
(Residence)
E!e"ience
in t#e line
of acti$it%
STATE BANK OF INDIA:
ANNEXURE - A
A..LI+ATION FORM FOR MSEs - Upto Rs 25 Lakh
To &e su&mitted along 'it# documents as !e" t#e c#ec(list
!For O&&#$) Us)(
) NAME O* THE ENTERPRISE
+ RE,D- O**I.E ADDRESS
/ ADDRESS O* *A.TOR01 SHOP
2 3HETHER 4ELON,S TO S.1ST1O4.1MINORIT0
Tele!#one No-
(Office)
E Mail
Add"ess
Mo&ile No- PAN .a"d No-
5 .ONSTIT6TION P"o!"ieto"%1 Pa"tne"s#i! fi"m1 P$t Ltd1 Ltd .om!an%1 .o7o! Societ%
8 DATE O* ESTA4LISHMENT
9 NAME O* PROPRIETOR1 PARTNERS1 DIRE.TORS O* .OMPAN0 AND THEIR
ADDRESSES
Name of Associate
.once"n
Add"ess of
Associate
.once"n
P"esentl%
4an(ing 'it#
Natu"e of
Association
Etent of Inte"est as a
P"o!-1Pa"tne"1Di"ecto"
o" :ust In$esto" in
Associate conce"n
T%!e of
facilit%
Limit
(in lacs)
Outstanding
as on ;;-
P"esentl%
&an(ing
'it#
Secu"it%
Lodged
Rate of
Inte"est
Re!a%ment
Te"ms
.u""ent A1c
.as# ."edit
Te"m Loan
L.14,
If &an(ing 'it# t#is 4an(< .ustome" No- &e gi$en #e"e
T%!e of
facilit%
Amount
(in lacs)
Pu"!ose fo"
'#ic#
"edui"ed
Secu"it% Offe"ed
P"ima"% Secu"it% (Details
'it# a!!"o- $alue to &e
mentioned)
3#et#e" .ollate"al
Secu"it% offe"ed (Please
mention %es o" no) (If %es<
t#en !"o$ide details in
.olumn )+)
.as# ."edit 0ES 1 NO
Te"m Loan 0ES 1 NO
L.14, 0ES 1 NO
= A.TI>IT0 Eisting
P"o!osed
(?)
? If a diffe"ent acti$it% ot#e" t#an eisting acti$it% is !"o!osed
@ NAMES O* ASSO.IATE .ON.ERNS AND NAT6RE O* ASSO.IATIONA
)B Relations#i! !f P"o!"ieto"1Pa"tne"1Di"ecto"
'it# t#e officials of t#e 4an(1Di"ecto" of t#e 4an(
)B(a) .REDIT *A.ILITIES (ECISTIN,) (Rs- in lacs)
)B(&) It is ce"tified t#at ou" unit #as not a$ailed an% loan f"om an% ot#e" 4an(1 *inancial
Institution in t#e !ast and I am not inde&ted to an% ot#e" 4an(1 *inancial Institution ot#e"
t#an t#ose mentioned in )B(a) a&o$e-
)) .REDIT *A.ILITIES (PROPOSED)A
In case of te"m loan "eDui"ements< t#e details of mac#ine"% ma% &e gi$en as unde"A
Past Pe"fo"mance1 *utu"e Estimates (Actual !e"fo"mance fo" t'o !"e$ious %ea"s< estimates
fo" cu""ent %ea" and !"oEection fo" net %ea" to &e !"o$ided fo" 'o"(ing ca!ital facilities-
Ho'e$e" fo" te"m loan facilities< !"oEections to &e !"o$ided till t#e !"o!osed %ea" of
"e!a%ment of loan)A
(Rs in lacs)
PAST 0EAR7II
(Actual)
PAST 0EAR7I
(Actual)
PRESENT 0EAR
(Estimates)
NECT 0EAR
(P"oEection)
Net Sales
Net P"ofit
.a!ital (Net
'o"t# in case
of com!anies)
Statuto"% O&ligation 3#et#e"
com!lied 'it#
(3"ite 0es1No)-
If not a!!lica&le<
t#en '"ite N-A-
Rema"(s (An% details in
connection 'it# t#e "ele$ant
o&ligation to &e gi$en)
)- Regist"ation unde" S#o!s and Estd Act
+- Regist"ation unde" SSI (P"o$isional1
*inal)
/- D"ug License
2- Latest Sales ta "etu"n filed
5- Latest Income ta "etu"n filed
8- An% ot#e" statuto"% dues "emaining
outstanding
Type of
machine
Purpose for
which
required
Whether
imported or
indigenous
Name of
supplier
Total cost of
machine (in case
of imported
machine, the
breakup of basic
cost, freight,
insurance and
customs duty be
given)
Contribution
being made by
the promoters
Loan
required
)+- Details of .ollate"al Secu"it% offe"ed< if an%< including /
"d
!a"t% gua"antee F
(F As !e" R4I guidelines< &an(s a"e not to ta(e collate"al secu"it% fo" loans u!to Rs- 5 la(#s to
MSME units)
)/
)2 Status "ega"ding Statuto"% O&ligationsA
SPA.E *OR PHOTO SPA.E *OR PHOTO SPA.E *OR PHOTO
Signatu"es of P"o!"ieto"1 Pa"tne"1 Di"ecto" '#ose !#oto is affied a&o$e
Onl% one !#oto of !"o!e"ito" 1 eac# Pa"tne" 1 Eac# 'o"(ing Di"ecto" is "eDui"ed to &e
affied- Eac# !#oto 'ill &e ce"tified1attested &% t#e 4"anc# Team 'it# name and
signatu"es on t#e !#otog"a!# 'it# 4"anc# stam!- T#e conce"ned staff 'ill !ut #is name
&elo' t#e signatu"es-
)5
)8 DateA PlaceA
I13e ce"tif% t#at all info"mation fu"nis#ed &% me1us is t"ueG t#at I13e #a$e no &o""o'ing
a""angements fo" t#e unit ece!t as indicated in t#e a!!licationG t#at t#e"e is no o$e"dues1statuto"%
dues against me1us1!"omote"s ece!t as indicated in t#e a!!licationG t#at no legal action #as
&een1is &eing ta(en against me1us1!"omote"sG t#at I13e s#all fu"nis# all ot#e" info"mation t#at ma%
&e "eDui"ed &% %ou in connection 'it# m%1ou" a!!lication t#at t#is ma% also &e ec#anged &% %ou
'it# an% agenc% %ou ma% deemed fit and %ou< %ou" "e!"esentati$es< "e!"esentati$es of t#e Rese"$e
4an( of India o" an% ot#e" agenc% as aut#o"ised &% %ou< ma%< at an% time< ins!ect1$e"if% m%1ou"
assets< &oo(s of account etc- in ou" facto"%1&usiness !"emises as gi$en a&o$e-
ANNEXURE-B -- For Oth)rs A'ou%t *#s) !App"#$at#o% &or'(
State Bank of India


Annexure SSI /1


Small Scale Industries

Application Form
For credit facilities up to Rs. 10 lacs

Note : Item 18 to be filled in by those applying for credit facilities above Rs. 50,000/-

1. Name of the Unit:
Constitution (Please (Proprietary / Partners /
strike out which ever Co-operative Society)
is not applicable)

2. Registration No.: (as given by the District Industries Centre /
Directorate of Industries)

3. Business Address:


Residential Address:


4. Background (To be filled up for each individual)
4.1 Name(s) of the Proprietor / Partners

Surname Name Fathers / Husbands Name Age Sex




4.2 Whether the applicant belongs to Yes / No
Scheduled Caste / Tribe /Minority
Community. If yes, please furnish
proof thereof.

4.3 Whether the applicant is Ex- Yes / NO
Serviceman. If yes, please furnish
proof thereof.

4.4 Present annual income of the family
with brief details of the sources
(Indicate farm income & non-farm
income separately)

State Bank of India


5. Size of the applicants family Adult ______ Children _____
6. Please furnish ration card No. and
Name of the Issuing Office
7. Size and particulars of land
holdings, if any, in the name of the
applicant of family members
8. Minimum amount required per Rs. ______________
month for family maintenance
9. Cost of the project Fixed Assets RS. ________
Current Assets Rs. ________
Total Rs. ________
10. Brief description of the industrial
activity
10.1 Existing

10.2 Proposed

11.1 Number of persons presently (to be filled in case of existing
unit only)

11.2 Number of persons proposed to be
Employed

12. How the activity was financed so far (to be filled in case of existing
unit only)
Source of
Funds (*)
Security Rate of Int. Repayment
per Month
Present
Outstanding
Amount of
Default (if
any)




(*) (Indicate name & address of the sources of funds, e.g. banks / financial institutions /
other (specify)
13. Raw materials required (quantity) and sources of supply:
14. Location of the market for the product(s):
15. Financial Projections:

Particulars 1
st
Year 2
nd
Year 3
rd
Year
Turnover
Raw Material
Purchases

Other Expenses
Profit

(Indicate the assumptions based on which the above figures have been worked out)
State Bank of India


16. Purpose of the new loan

17. Amount of loan required

18. Means of Financing
18.1 Promoters contribution
18.2 Subsidy
18.3 Seed Capital
18.4 Loan (Working Capital / Term Loan)

I / We certify that all information furnished by me /us is true; that I / We have no
borrowing arrangements for the unit with any bank except as indicated in this application;
that there is no overdues / statutory dues against me / us except as indicated in this
application; that no legal action has been / is being taken by against me / us; that I / we
shall furnish all other information that may be required by you in connection with my /
our application; that this may also be exchanged by you with any agency you may deem
fit and you, your representatives, representatives of the Reserve Bank of India / National
Bank for Agriculture and Rural Development / Small Industries Development Bank of
India 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.













(Affix a photo, in case of thumb impression)

Date Signature / Thumb impression of the Borrower

Place

State Bank of India


Annexure SSI /2

Small Scale Industries

Application Form
For credit facilities of over Rs. 10 lacs & up to Rs. 50 lacs

1. Name of the Unit:
(In block letters)
1.2 Constitution: (Proprietary / Partnership Firm /
(Please strike out whichever is not Private Limited Company /
applicable) Public Limited Company /
Co-operative Society)
1.3 Name of the business house / group :
(if any)
2.1 Registration No. :
(As given by the District Industries
Centre / Directorate of Industries)

2.2 Date of Incorporation /
Commencement of Business:
3 Business Address with Telephone / Telex Number
3.1 Registered Office:

3.2 Administrative Office:

3.3 Factory:


4. Background of the (Please furnish background for
Proprietor / Partners / Directors each person as per the
Appendix I)

5. Brief description of the Industrial activity
5.1 Existing
5.2 Proposed

6. How the Activity was financed so far:
(to be filled in case of existing unit only)
Source of Funds (*) Security Rate of
Int.
Repayment
Per month
Present O/s. (in
000s of Rs.)
Amount of
Default (if any)



(*) Indicate sources of funds with name & address, e.g. banks/ financial institutions /
others specify)
State Bank of India


7. Past performance for last three years (to be filled by existing unit only)

(in 000s of Rs.)

Particulars 20__ 20__ 20__
Turnover
Net Profit
Retained Profit

Monthly Turnover for last twelve months

Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec



8. Arrears in Statutory payments (if any)

a) Income tax
b) Sales tax
c) Provident Fund
d) Employees State Insurance Corporation
e) Others (specify)

9. If the unit is an ancillary unit, the undertaking to which it is catering and its
address



10. Name of the associate concern(s), if any


10.1 Nature of association and amount invested


10.2 Nature of activity


10.3 Items traded / manufactured


10.4 Turnover and profit during preceding three years.



State Bank of India


11. Employment Present Proposed
Executives
Supervisory
Administrative / Office Staff
Skilled Labour
Unskilled Labour
12. Technical Feasibility ________________

12.1 Name of the product(s), including Bye-products & its (their) use

12.2 Manufacturing Process, in brief (Indicate to the extent possible, stage-wise
capacity data, yield/ conversion data, material flow, etc.



12.3 Capacity: (No . of Units / Quantity in kg. / Volume in litre per annum)
Capacity for each
product
Licensed Installed Operating



Number of working days in a month and Number of shifts in a day:

12. 4 Locational advantages of existing and /or proposed premises and with
reference to
i) absence of civic restrictions
ii) proximity to the source of raw materials
iii) market for the product
iv) availability of
a) power
b) water
c) labour
d) transport
v) whether clearance has been
obtained from the pollution control authority?
12. 5 Land & Building

Area / Plinth Area (in sq. meters) Value (in 000s of Rs.)
Existing Proposed Existing Proposed
Factory Land
Factory
building

Ancillary
building

Open Storage
Space

State Bank of India




12.6 Type of soil and load bearing capacity (enclose test report)

Enclosures:
a) certified photo copy of sale / lease deed
b) certified photo copy of the Govt. order converting the land into
industrial land, if applicable
c) locational map
d) certified photo copy of the site plan of the land and blueprints of the
buildings duly approved by Corporation / Municipality / Panchayat.

12.7 Particulars of Machinery & other assets : As per Appendix II

12.8 Necessity & purpose for the proposed investment / addition to factory premises /
machinery (in case where such investment is intended) for achievement of the
anticipated turnover.



12.9 Raw Materials / Components
(Please mention about the imported and indigenous items separately)
Name / Brief description of the items

(A) (B) ( C) (D)
Quantity
Required

Sources of Supply
Minimum Purchase
Quantity

Lead / Procurement Time
Available throughout the
year

If answer to the above is
no, then no. of months it is
available

(enclose proforma invoices in respect of each item, if available)

13. Utilities
(Give comments on requirement, availability adequacy, qualitative aspects, etc.)
a) Power
Contracted Load

Connected Load


State Bank of India


Future power consumption
(in no. of units) per month

(Enclose certified Xerox copy of sanction for power connection)

b) Water

c) Fuel

d) Others (specify)

14. Economic Feasibility
Marketing (mention separately for each product)


14.1 Whether the product is reserved exclusively for the SSI sector?


14.2 Name of the Major customers


14.3 Region / Area where the product is / will be sold


14.4 Extent of competition & No. of Units engaged in similar line in the area


14.5 How does the unit meet / propose to meet the competition?
(comment on the competitive advantages enjoyed by the unit)


14.5.1 In price and quality, how does the units product compare with those of its
competitors?


14.5.2 Is the Unit selling direct to its customers? If so please furnish details like sales
force, showrooms, depots, etc.


14.5.3 If a selling / distribution agency has been appointed, its name, period of contract,
commission payable, period by which the bills will be paid by it etc. (enclose
copies of agreement, wherever such agreement has been entered into)


14.6 Nature and volume of orders / enquiries on hand
(certified Xerox copies to be furnished)
State Bank of India




14.7 If the Unit is export oriented, please furnish exporter code no., if allotted,
And relevant details as under in the preceding three years:-

Code No.:

Name of the product
exported
Name of the Country where
Exported
F.O.B Value in US $



15. Cost of Project
(Please furnish estimates of cost of project under the following heads, Indicate the
basis for arriving at the cost of project)

(In 000s of Rs.)

Sr.
No.
Particulars Already
Incurred
To be incurred Total Cost
A Land including
development

B Building & Other Civil
Works

C Plant & Machinery
1) indigenous
2) Imported

D Essential Tools, Spares &
Accessories

E Testing Equipment
F Miscellaneous Fixed
Assets

G Erection / Installation
Charges

H Preliminary Expenses
I Pre-Operative Expenses
J Provision for
Contingencies
1. Buildings
2. Plant & Machinery
3. Other Fixed Assets

K Margin for Working
Capital Required

L Total


State Bank of India



16. Means of Financing
(Please furnish details of sources of finance for meeting the cost under the
following heads)
(In 000s of Rs.)

Sr.
No.
Particulars Amount
Already Raised
Amount
Proposed to be
Raised
Total
A Capital (specify resources
contributing capital)

B Reserves
C Term Loans
(give full particulars

D Unsecured Loans and
Deposits
(indicate sources, rate of
interest, repayment period,
etc.)

E Deferred Payment
Arrangements including
Suppliers Credit

F Subsidy
Central Govt.
State Govt.

G Seed Capital
(indicate sources)

H Internal Cash Accruals
I Other Sources (specify)
J Total

16.1 In case internal accruals are taken as source of finance, explain the basis for
estimation of internal accruals by means of a statement.

16.2 Indicate sources from which expenditure already incurred has been financed


16.3 Promoters contribution to the project as % of the total cost

(Please furnish list of persons / firms who would be contributing to promoters
share of the capital and the respective amounts and their relationships)



State Bank of India



17. Schedule of Implementation
Please indicate the progress made so far in the implementation of the project and
furnish the schedule of implementation as follows
Date of Expected date of
commencement completion
a) Acquisition of Land
b) Development of Land
c) Civil works for
Factory building
Machinery Foundation
Administrative Building
d) Plant & Machinery
Imported
Indigenous
e) Arrangement for power
f) Arrangement for water
g) Erection of equipment
h) Commissioning
i) Initial Procurement of Raw
Material
j) Trial Runs
k) Commercial Production


18. Future Projections
(To be given for the next three years)


Please furnish data on projected profitability as per Appendix III
Please furnish data on projected cash flow statement as per
Appendix IV.
Percentage of Cash Sales in Total Sales ____%
Period in which payment is received in respect of credit sales
___ days
Average credit available on purchases
____ days

19. Working Capital Required for the Anticipated Turnover:
(Please furnish data as per Appendix VI)

20. Repayment Programmes:




State Bank of India



21. Details of Securities to be offered


21.1 Primary
(Working capital and term loan
securities to be indicated separately)


21.2 Collateral, if any, (give full details)




21.3 Details of guarantor(s)



21.3.1 Name


21.3.2 Residential Address



21.3.3 Occupation
(if in service, name, & address of
his / her employer)



21.3.4 Details of Movable & Immovable
Property (ies) Owned by him / her &
Other dependent family members




21.3.5 Details of any similar guarantee, if
Any, given to other institutions



I / We certify that all information furnished by me / us is true; That I / We have no
borrowing arrangements for the Units with any bank except as indicated in the
application; that there is no overdues / statutory dues against me / us / promoters except
State Bank of India


as indicated in the application; that no legal action has been / is being taken against me /
us / promoters; that I / We shall furnish all other information that may be required by you
in connection with my / our application; that this may also be exchanged by you with any
agency you may deem fit and you, your representatives, representatives of the Reserve
Bank of India / National Bank of Agriculture & Rural Development / Small Industries
Development Bank of India / Deposit Insurance and Credit Guarantee Corporation of 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.

Date __________________
Place Signature of the Borrower
(Name & Designation)

Encl.: Certified Xerox copies of
a) Balance Sheets with Trading and Profit & Loss Account for the last three
years.
b) Memorandum and Articles of Association, Certificate for Commencement
of Business.
c) Income Tax, Wealth Tax Returns and assessment orders for the last
Three years, for the unit as well as proprietors / partners / Directors
d) Sales Tax Returns for the last three years.

Forms as per Appendix SSI-I to Appendix SSI- VI given hereafter should also be
submitted along with the application for advances above Rs. 10 lacs,
State Bank of India


Annexure SSI /3
Small Scale Industries

Application Form
For Credit Facilities of over Rs. 50 lacs & upto Rs. 5 crores

1.1 Name of the Unit
(In block letters)
1.2 Constitution: (Proprietary / Partnership Firm /
(Please strike out whichever is not Private Limited Company /
applicable) Public Limited Company /
Co-operative Society)
1.3 Name of the business house / group :
(if any)
2.1 Registration No. :
(As given by the District Industries
Centre / Directorate of Industries)

2.2 Date of Incorporation /
Commencement of Business:
3 Business Address with Telephone / Telex Number
3.1 Registered Office:

3.2 Administrative Office:

3.3 Factory:


4. Background of the (Please furnish for
Proprietor / Partners / Directors each person as per the
Appendix I)

5. Brief description of the Industrial activity
5.1 Existing
5.2 Proposed

6. How the Activity was financed so far: (to be filled in case of existing unit only)
Source of Funds (*) Security Rate of
Int.
Repayment
Per month
Present O/s. (in
000s of rs.)
Amount of
Default (if any)



(*) Indicate sources of funds with name & address, e.g. banks/ financial institutions /
others specify)


State Bank of India


7. Past Performance
(To be filled by the existing unit only)
(Indicate in 000s of Rs.)
Particulars Last Year Last but One year Last but two years
Turnover
Net Profit
Retained Profit

Monthly Turnover for last twelve months

Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec


8. Arrears in Statutory payments (if any)

a) Income tax
b) Sales tax
c) Provident Fund
d) Employees State Insurance Corporation
e) Others (specify)

9. If the unit is an ancillary unit, the undertaking to
which it is catering and its address

10. Name of the associate concern(s), if any

10.1 Nature of association and amount invested

10.2 Nature of activity

10.3 Items traded / manufactured

10.4 Turnover and profit during preceding three years.

11. Employment Present Proposed
Executives
Supervisory
Administrative / Office Staff
Skilled Labour
Unskilled Labour
State Bank of India



12. Technical Feasibility

12.1 Name of the product(s),
including Bye-products & its
(their) use

12.2 Manufacturing Process,
in brief (Indicate to the extent
possible, stage-wise capacity data,
yield/ conversion data, material flow, (etc).


12.3 Capacity: (No . of Units / Quantity in kg. / Volume in litre per annum)


Capacity for each
product
Licensed Installed Operating





Number of working days in a month
and Number of shifts in a day:

12.4 Locational advantages of existing
and /or proposed premises and with
reference to

i) absence of civic restrictions
ii) proximity to the source of raw materials

iii) market for the product
i) availability of
a) power
b) water
c) labour
d) transport
v) whether clearance has been
obtained from the pollution control authority?
State Bank of India





12.5 Land & Building

Area / Plinth Area (in sq. metres) Value (in 000s of Rs.)
Existing Proposed Existing Proposed
Factory Land
Factory
building

Ancillary
building

Open Storage
Space




12.6 Type of soil and load bearing capacity (enclose test report)



Enclosures:
a) certified photo copy of sale / lease deed
b) certified photo copy of the Govt. order converting the land into
industrial land, if applicable
c) locational map
d) certified photo copy of the site plan of the land and blueprints of the
buildings duly approved by Corporation / Municipality / Panchayat.



12.7 Particulars of Machinery & other fixed assets :
As per Appendix II


12.8 Necessity & purpose for the proposed investment / addition to factory premises /
machinery (in case where such investment is intended) for achievement of the
anticipated turnover.








State Bank of India





12.9 Raw Materials / Components
(Please mention about the imported and indigenous items separately)
Name / Brief description of the items

(A) (B) ( C) (D)
Quantity
Required

Sources of Supply
Minimum Purchase
Quantity

Lead / Procurement Time
Available throughout the
year

If answer to the above is
no, then no. of months it is
available

(enclose proforma invoices in respect of each item, if available

13. (Give comments on requirement, availability / adequacy, qualitative aspects, etc.)

13.1 Power
Contracted Loan

Connected Load

Future power consumption
(in No. of units) per month

Standby arrangements

(enclose certified Xerox copy of sanction for power connection)

13.2 Water

(Enclosed certified Xerox copy of sanction for water connection)

13.3 Fuel

13.4 Others (specify)




State Bank of India


14. Quality Control

14.1 Details of arrangement made for
Quality control. If BIS/FPO/ISO
Specifications are followed, no. of
BIS / FPO/ISO standards and the
Particulars thereof should be
Provided

14.2 Particulars of R & D activity
Proposed

15. Economic Feasibility

Marketing (mention separately for
Each product)
15.1 Whether the product is reserved
exclusively for the SSI sector
15.2 Name of the major customers


15.3 Region / Area where the product
is / will be sold
15.4 Extent of competition and No. of
units engaged in similar line in the
area
15.5 How does the unit
meets / proposes to meet the
competition (comment on the
competitive advantages enjoyed
by the unit)
15.5.1 In price and quality, how does the
units product compare with those
of its competitors
15.5.2 Is the unit selling direct to its
customers ? If so, please furnish
details like sales force, showrooms,
depots, etc.
15.5.3 If a selling /distribution agency has
been appointed, its name, period
of contract, commission payable,
period by which the bills will be
paid by it etc.
(enclose copies of agreement,
wherever such agreement has been
entered into)
State Bank of India


15.6 Nature and volume of
orders / enquiries on hand
(certified Xerox copies to be
furnished)
15.7 If the units is export oriented,
please furnish exporter code no., if
preceding three years.

Code No.:

Name of the Product
Exported
Name of the Country where
Exported
F.O.B Value in US $










16. Cost of Project
(Please furnish estimates of cost of project under the following heads, Indicate the
basis for arriving at the cost of project)
(In 000s of Rs.)
Sr.
No.
Particulars Already
Incurred
To be Incurred Total
Cost
A Land including development
B Building & Other Civil Works
C Plant & Machinery
1) Indigenous
2) Imported

D Essential Tools, Spares and
Accessories

E Testing Equipment
F Miscellaneous Fixed Assets
G Erection / Installation Charges
H Preliminary Expenses
I Pre-Operative Expenses
J Provision for Contingencies
1. Buildings
2. Plant & Machinery
3. Other Fixed Assets

K Margin for Working Capital
L Total
State Bank of India



17 Means of Financing
(Please furnish details of sources of finance for meeting the cost under the
following heads)
(In 000s of Rs.)
Sr.
No..
Particulars Amount
Already
Raised
Amount
Proposed
to be
Raised
Total
A Capital
(specify resources contributing capital)

B Reserves
C Term Loans
D Unsecured Loans and Deposits
(indicate sources, rate of interest, repayment
period etc.)

E Deferred payment Arrangements
Including Suppliers credit

F Subsidy
Central Govt.
State Govt.

G Seed Capital
(indicate sources)

H Internal Cash
Accruals

I Other Sources
(specify)

J Total

16.1 In case internal accruals are taken as
Source of finance, explain the basis
For estimation of internal accruals by
Means of a statement
17.2 Indicate sources from which
expenditure already incurred has
been financed
17.3 Promoters contribution to the
project as % of the total cost

(please furnish list of person / firms
who would be contributing to the
promoters share of the capital and
the respective amounts and their
relationships)


State Bank of India


17 Schedule of Implementation

Please indicate the progress made so far in the implementation of the project and
Furnish the scheduled of implementation as follows

Date of
Commencement
Expected Date of
Completion
a) Acquisition of Land
b) Development of Land
c) Civil works for Factory
building Machinery
Foundation
Administrative Building

d) Plant & Machinery Imported
Indigenous

e) Arrangement for power
f) Arrangement for water
g) Erection of equipment
h) Commissioning
i) Initial Procurement of Raw
Material

j) Trial Runs
k) Commercial Production

19 Future Projection
(to be given for the next five years) please furnish data on
19.1 Projected profitability as per Appendix III
19.2 Projected cash flow statement as per Appendix IV
19.3 Projected balance sheet as per Appendix V
19.4 Working capital requirement as per
Appendix VI
Percentage of Cash Sales to Total Sales _________%
Period in which payment is received in
Respect of credit sales _______ days
Average credit available on purchases _______ days
20. Financial Assistance required
20.1 Rupee Loan
20.2 Foreign Currency Loan
20.3 Term Loan
20.4 Working Capital (as worked out in
Appendix VI)
20.5 Non-Fund Based Limits, i.e. other
Forms of assistance (e.g. L/Cs, Bank
Guarantee, etc.)

21 Repayment Programme
State Bank of India


22 Details of Securities to be Offered
22.1 Primary (working capital and term loan
Securities to be indicated separately)
22.2 Collateral, if any
(full details)
22.3 Details of guarantor(s)
22.3.1 Name
22.3.2 Residential Address
22.3.3 Occupation (if in service, name & address of
his /her employer)
22.3.4 Details of Movable & Immovable
Property(ies) owned by him / her & other
Dependent family members
22.3.5 Details of any similar guarantee, if any, given
to other institutions
23 Whether any Government enquiry,
Proceedings or prosecution has been
Instituted against the unit or its
Proprietor / partners / directors for any
Offence ? If so, please give details.
24. Details of pending litigation, if any, against
And by the unit.
25. Please indicate whether the proprietor / any
of the partners, promoters / directors have at
any time declared themselves as insolvent If
so, details thereof.

I / We certify that all information furnished by me / us is true; that I / We have no
borrowing arrangements of the unit with any bank except as indicated in the application;
that there is no overdues / statutory dues against me / us / promoters except as indicated
in the applications; that no legal action has been / is being taken against me / us /
promoters; that I / We shall furnish all other information that may be required by you in
connection with my / our application; that this may also be exchanged by you with any
agency you may deem fit and you, your representatives, representatives of the Reserve
Bank of India / National Bank of Agriculture and Rural Development / Small Industries
Development Bank of India / Deposit Insurance & Credit Guarantee Corporation 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.



Signature of the Borrower
(Name & Designation)

Date
Place
State Bank of India



Encl: Certified Xerox Copies of

a) Audited balance Sheets with Trading and Profit & Loss Account, for the
last three years.
b) Memorandum and Articles of Association, Certificate of
Commencement of Business.
c) Income tax, Wealth tax Returns and assessment orders for the last three
years, for the unit as well as proprietor / partners / promoters / directors.
d) Sales Tax Returns for the last three years



Forms as per Appendix SSI-I to Appendix SSI- VI given hereafter should also be
submitted along with the application
State Bank of India


Annexure-SSI/4

STATE BANK OF INDIA
SMALL SCALE INDUSTRIES

Application Form
For Credit Facilities of over Rs.5 crores.

1.1 Name of the Unit
1.2 Constitution Proprietary/Partnership/Private Limited Concern/
Co-operative Society
(Please strike out which are not applicable)

1.3 Name of the business house/group to which the unit belongs

2.1 Registration No. :
(as given by the District Industries Centre, Directorate of Industries)
2.2 Date of incorporation/commencement of business

3. Business Address with Telephone/Telex/Fax No.

3.1 Registered Office
3.2 Administrative Office
3.3 Factory

4. Background of Proprietor/Partners /Promoters/Directors
(Please furnish information for each person as per in Annexure-I)
5. Description of the Industrial Activity
5.1 Existing

5.2 Proposed


6. How the Activity was financed so far (to be filled in case of existing unit only)

Source of
Funds(*)
Security Rate of Unit Repayment
per month
Present
O/s.
Amount of
Default (if any)







(*) Indicate source of funds with name & address e. g. Banks/financial institutions/others
(specify)
State Bank of India





7. Arrears in Statutory Payments (if any)
a) Income Tax
b) Sales Tax
c) Provident Fund
d) Employees State Insurance Corporation
e) Other (specify)

8. Past Performance for the last three years (in case of existing units)

Particulars 20__ 20__ 20__
Turnover
Net Profit
Retained Profit

9. Monthly Turnover for last twelve months.

JAN FEB MAR APR MAY JUN

JUL AUG SEP OCT NOV DEC


9.1 MANAGEMENT
(Please furnish background of the main promoter other than those furnished in
Annexure-1. write-up on other companies, if any, promoted by him or with which
he is associate together with a copy of the latest balance sheet)




9.2 In case the promoter is a Limited Company, please furnish a write-up on the
activities and past performance of the company and any other expansion
programme(s)/diversification contemplated
(a) Memorandum & Article of Association


(b) Audited Balance Sheet and Trading and Profit Loss A/cs for the last three
years of the promoter company.

Copy of the agreement(s), if any, entered into among the promoters.




State Bank of India



9.3 SHAREHOLDING

9.3.1 Please provide a list of shareholders under the heads

a) Promoters
b) Other major groups
c) Foreign collaborations
d) NRI shareholders
e) Other institutions
Owing or controlling 5% or more of equity shares, indicating the amount owned
and business relationship, if any, with the company.

9.3.2 In case of preference shareholder, please give a list of ten largest shareholders.
9.3.3 Also furnish number of equity shareholders and preference shareholders

9.4 Employment Present Proposed

Executives
Supervisory
Administrative/Office Staff
Skilled Labour
Other (specify)

9.5 Particulars of existing key technical and executive staff
(Please furnish for existing as well as proposed staff)

Name Designation Qualification Experience Any Special
achievement
(Inventions/
Research etc.)
Functional
Duties at the
Unit.






10. If the unit is an ancillary unit, the
undertaking to which it is catering and its address

11. Name of the associated concern(s), if any and

11.1 Nature of Association and amount invested
11.2 Nature of Activity
11.3 Items traded/manufactures
11.4 Turnover and profit during preceding three years.
State Bank of India





12. Technical Feasibility (Please enclose the
Feasibility / project report)
12.1 Name of the Products (including by-products)
& its (their) use

12.2 Manufacturing Process, in brief, (indicate
technical process, whether it is a continuous
process, whether this has been tried in the country,
stage-wise capacity data, yield/conversion data,
Material flow etc.)
12.3 Capacity of Units/Quantity in Kg./Volume in Liters)

Capacity of
each product
Licensed Installed Operating







12.4 No. of working days in a month & No. of shifts in a day
12.4.1 In case of any collaboration, please furnish a brief
write-up on the period of collaboration agreement,
the name of the collaborator company, indicating
the activities. Size, turnover, particulars of the
existing plants, other projects in India and abroad
set up with same collaboration.
a) Copy of the published brochure highlighting the
activities of the collaborator and balance sheet
for the latest year.
b) Copy of the collaboration agreement
c) Fees/royalties payable and the manner in which
payable.
d) Copy of the government approval, if required
for the service of foreign technicians, if any.
12.4.2 If there is no collaboration agreement please
furnish full details of arrangement proposed to
be made for obtaining technical advice and
service needed for the implementation of the
project.


State Bank of India






12.4.3 Particulars of the Consultants :
a) Name and address of the consultants
b) Fees payable and the manner in which
payable
c) Scope of work assigned to them
d) Brief particulars of consultants including
organizational set-up, bio-data of senior
personnel, names of directors/partners,
particulars of work done in the past and
work on hand. Please enclose a copy of
the agreement with the consultants, and in
case of foreign consultant(s) approval of
the Government.

12.4.4 Whether any of the partners/
promoters/directors have any interest in
consultant/collaborator firm. If so, details to
be furnished
12.5 Locational advantages of existing and/or
proposed premises with reference to :
i) absence of civic restrictions
ii) proximity to the source of raw materials
iii) market for the product
iv) availability of
a) power
b) water
c) labour
d) transport

12.6 LAND & BUILDING
Area/Plinth area
(in sq. metres)
Value (in 000sof Rs.)
Existing Proposed Existing Proposed
Factory Land
Factory Building
Ancillary Building
Open Storage Space
(enclose Test Report)




State Bank of India






12.7 Type of soil and load bearing capacity
Enclosures :
a) Certified zerox copy of sale/lease deed
b) Certified zerox copy of the Govt. Order converting
the land into industrial land, if applicable.
c) Locational map
d) Certified zerox copy of the site plan of the land showing contour lines, the
internal road, power receiving station, railway siding, tube-wells, etc. and
blue-prints of the building duly approved by corporation/municipality
panchayat.
12.8.1 Please furnish the following particulars of Architects
12.8.1.1 Name and address of the architects/firm


12.8.1.2 Scope of work.

12.8.1.3 Rates quoted and detailed estimate of expenses

12.8.1.4 Fees payable and manner in which payable.

12.8.1.5 Time schedule

12.8.1.6 Penalties

12.8.1.7 Past experience of the architects in the similar work

12.9 PARTICULARS OF MACHINERY & OTHER FIXED ASSETS
As per Annexure II
12.9.1 If sub-contract of any portion of production is envisaged, the production stages
in which the sub-contracting will be done.
Details to indicate the availability of machinery particulars with the sub-
contractors with adequate spare capacity.




12.9.2 Arrangements made for erection and commissioning of the plant.


12.10 Necessity & purpose for the proposed investment/addition to factory
premises/machinery (in case where such investment is intended) for
achievement of the anticipated turnover.
State Bank of India




12.11 RAW MATERIALS & COMPONENTS
(Please mention about the imported and indigenous items separately)
(A) (B) (C) (D)
Quantity Required
Sources of Supply
Minimum Purchase
Quantity

Lead/Procurement
Time

Available throughout
the year

If answer to above is
no then no. of months
& period when it is
available

(enclose copies of proforma invoices in respect of each item)

13. UTILITIES (Give comments on requirement, availability/adequacy, qualitative
aspects etc.)
13.1 Power
13.2 Sources of Power and Supply Voltage
- Taken from Electricity Board
- Own generation
- Stand-up arrangements
13.1.2 Maximum Demand
13.1.3 Contracted Load
13.1.4 Connected Load
13.1.5 Energy Consumption per year
13.1.6 Power Tariff
13.1.7 Cost of Power per annum at maximum capacity utilization
Please enclose
a. Certified zerox copy of sanction for power
b. Certified zerox copy of agreement with electricity board.
c. Certified zerox copy of electrical layout of the plant.

13.2 Water :
13.2.1 Indicate the requirements and suitability of water
13.2.2 Describe the water treatment arrangement
13.2.3 Sources for supply of water arrangement
Proposed and water charges payable
13.3 Steam :
13.3.1 Requirement of steam
13.3.2 Capacity of boiler
13.3.3 Arrangements proposed for steam
State Bank of India


13.4 Compressed Air :
13.4.1 Requirements of compressed air
13.4.2 Arrangements proposed for compressed air
13.5 Fuel :
13.5.1 Requirement of fuel
13.5.2 Arrangements proposed for supply
13.6 Arrangement proposed for carrying raw materials.
14. EFFLUENT
Please furnish full details of the value of atmosphere, soil and water pollution
likely to be created by the project and measures proposed for control of pollution.
Indicate whether necessary permission for the disposal of effluent has been
obtained from the concerned authority, if yes, a copy of the certificates should be
furnished.




15. QUALITY CONTROL
15.1 Details of arrangements made for quality control
If BIS/FPO/ISO specifications are followed, no. of
BIS/FPO/ISO standards and particulars thereof should be provided


15.2 Particulars of R&D activity proposed.

16 ECONOMIC FEASIBILITY
Marketing (mention separately for each product)
(Please enclose a Market Survey Report

16.1 Whether the product is reserved exclusively for the SSI Sector? If so, please
furnish Item Code No.

16.2 Names of the Major customers

16.3 Region/Area where the product is/will be sold

16.4 Extent of competition & No. of Units engaged in similar line in the area

16.5 How does units meat/propose to meet the competition
(Comment on the competitive advantages enjoyed by the unit)

16.5.1 In price and quality, how does the units product compare with those of its
competitors

16.5.2 Is the unit selling direct to its customers? If so, please furnish details like sales
force, showrooms, depots etc.
State Bank of India


16.5.3 If a selling/distribution agency has been appointed, its name, period of contract,
commission payable, period by which the bills will be paid by it etc. (enclose
copies of agreement, wherever applicable)

16.6 Nature and volume of orders/enquiries on hand (zerox copies to be furnished)

16.7 If the unit is export oriented, please furnish exporter code no., if allotted, and
relevant details as per the following details in the preceding three years.
Code No.:
Name of the Product
Exported
Name of the Country
where Exported
F.O.B. Value in US$





17. Cost of Project
(Please furnish estimates of cost of project under the following heads indicate the
basis for arriving at the cost of project)
(in 000s of Rs.)
Sr.No. Particulars Already
Incurred
To be
Incurred
Total cost
A. Landing including
development

B. Building & Other Civil
Works

C. Plant & Machinery
i) Indigenous
ii) Imported

D. Essential Tools, Spares &
Accessories

E. Testing Equipment
F. Miscellaneous Fixed
Assets

G. Erection/Installation
Charges

H. Preliminary Expenses
I. Pre-operative Expenses
J. Provision for
Contingencies
1. Buildings
2. Plant & Machinery
3. Other Fixed Assets

K. Margin for Working
Capital Required

L. Total
State Bank of India



18. Means of Financing
(Please furnish details of sources of finance for meeting the cost under the
following heads)
(in 000s of Rs.)
Sr.
No.
Particulars Amount
Already
Raised
Amount
Proposed to
be Raised
Total
A. Capital
(specify resources
contributing capital)

B. Reserves
C. Term Loans (give full
particulars)

D. Unsecured Loans and
Deposits (Indicate sources,
rate of interest repayment
period etc.)

E. Deferred Payment
Arrangements including
Suppliers Credit

F. Subsidy
- Central Govt.
- State Govt.

G. Seed Capital (indicate
sources)

H. Internal Cash Accruals
I. Other sources (specify)
J. Total

19.1 In case internal accruals are taken as sources of finance explain the basis for
estimation of internal accruals by means of a statement.

19.2 Indicate sources from which expenditure already incurred has been financed.

19.3 Promoters contribution to the project as % of the total cost.
(Please furnish list of persons/firms who would be contributing to the promoters
share of the capital and the respective amounts and their relationships).

20. Financial Assistance required :

20.1 Rupee Loan
20.2 Foreign Currency Loan
20.3 Underwriting
20.3.1 Equity Capital
20.3.2 Preference Capital
State Bank of India


20.3.3 Debentures
20.3.4 Guarantee of foreign currency loan/Deferred Credit
20.4 Guarantee for foreign currency loan/Deferred Credit
20.5 Working Capital (Please furnish as per Annexure-VI)
20.6 Other forms of assistance (e. g. LCs, Guarantees, etc.)

21. Schedule of Implementation :
Please indicate the progress made so far in the implementation of the project and
furnish the scheduled of implementation as follows :

Date of Expected
Commencement Date of Completion

a) Acquisition of Land
b) Development of Land
c) Civil Works for
- Factory Building
- Machinery Foundation
- Administrative Building
d) Plant & Machinery
- Imported
_ Indigenous
e) Arrangement for power
f) Arrangement for water
g) Erection of equipment
h) Commissioning
i) Initial procurement of Raw Material
j) Trial Runs
k) Commercial Production.

22. Future Projections
(To be given for the next five years)
Please furnish data on :

22.1 Projected profitability as per Annexure-III
22.2 Projected cash flow statement as per Annexure-IV
22.3 Projected balance sheet as per Annexure-V
22.4 Working Capital requirement as per Annexure VI
22.5 Percentage of Cash Sales in total Sales - -------%
22.6 Period in which payment is received in respect
of Credit Sales _______days
22.7 Average credit available on purchases _______ days
23. How far does the unit contribute to the establishment of ancillary units in the
region.


State Bank of India



24. Please furnish International/CIF/FOB Price of all inputs, which can be imported.


25. Government Consents:
Please indicate whether the various licenses / consents required for the project
have been obtained from the respective authorities.


24.1 Specify any special condition attached to the licenses / consents and the
Undertaking given by the company in connection therewith.

26 Repayment programme:

27 Details of securities to be offered

27.1 Primary
(working capital & term loan securities to be indicated separately)

27.2 Collateral (full details)

27.3 Details of guarantors(s)

27.3.1 Name

27.3.2 Residential address

27.3.3 Occupation
(if in service, name & address of his / her employer)

27.3.4 Details of Movable & Immovable Property (ies) owned by him / her & other
Dependent family members

27.3.5 Details of any similar guarantee, if any, given to other institutions.

28 Whether any Government enquiry proceedings of prosecution has been instituted
against the unit or its proprietors / partners / promoters / directors for any
offences? if so, please give details.

29 Details of pending litigation, if any, against and by the concern.

30. Please indicate whether any of the promoters of directors have at any time
declared themselves as insolvent.


State Bank of India


I / We certify that all information furnished by me / us is true; that I / We have no
borrowing arrangements for the unit with any Bank except as indicated in the application;
that there is no overdues / statutory dues against me / us / promoters except as indicated
in the application; no legal action has been / is being against me / us / promoters; that I /
We shall furnish all other information that may be required by you in connection with my
/ our application; that this may also be exchanged by you with any agency you may deem
fit and you, your representatives, representatives of the Reserve Bank of India / National
Bank of Agriculture and Rural Development / Small Industries Development Bank of
India / Deposit Insurance & Credit Guarantee Corporation 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.

Signature of the Borrower
(Name & Designation)

Date
Place

Encl: Certified Xerox Copies of

a) Audited balance Sheets with Trading and Profit & Loss Account, for the
last three years.
b) Memorandum and Articles of Association, Certificate of
Commencement of Business in case of limited companies..
c) Income tax, Wealth tax Returns and assessment orders for the last three
years, for the unit as well as proprietor / partners / promoters / directors.
d) Sales Tax Returns and assessment order for the last three years

Forms as per Appendix SSI-I to Appendix SSI- VI given hereafter should also be
submitted along with the application for advances above Rs. 10 lacs,

TRADE AND SERVICES
ANNEXURE-C - For MSEs upto 25 Lakh. (Application or!"
ANNEXURE-# - $%n%ral &nor!ation (Application or!"

NAME Age
Academic
Qualification
RESIDENTIAL
ADDRESS
TELEPHONE
(Residence)
E!e"ience
in t#e line
of acti$it%
S'A'E (AN) *F &N#&A+
ANNEXURE , C
A--L&CA'&*N F*RM F*R MSEs - Upto Rs 25 Lakh
To &e su&mitted along 'it# documents as !e" t#e c#ec(list
(For *ic% Us%"
) NAME O* THE ENTERPRISE
+ RE,D- O**I.E ADDRESS
/ ADDRESS O* *A.TOR01 SHOP
2 3HETHER 4ELON,S TO S.1ST1O4.1MINORIT0
Tele!#one No-
(Office)
E Mail
Add"ess
Mo&ile No- PAN .a"d No-
5 .ONSTIT6TION P"o!"ieto"%1 Pa"tne"s#i! fi"m1 P$t Ltd1 Ltd .om!an%1 .o7o! Societ%
8 DATE O* ESTA4LISHMENT
9 NAME O* PROPRIETOR1 PARTNERS1 DIRE.TORS O* .OMPAN0 AND THEIR
ADDRESSES
Name of Associate
.once"n
Add"ess of
Associate
.once"n
P"esentl%
4an(ing 'it#
Natu"e of
Association
Etent of Inte"est as a
P"o!-1Pa"tne"1Di"ecto"
o" :ust In$esto" in
Associate conce"n
T%!e of
facilit%
Limit
(in lacs)
Outstanding
as on ;;-
P"esentl%
&an(ing
'it#
Secu"it%
Lodged
Rate of
Inte"est
Re!a%ment
Te"ms
.u""ent A1c
.as# ."edit
Te"m Loan
L.14,
If &an(ing 'it# t#is 4an(< .ustome" No- &e gi$en #e"e
T%!e of
facilit%
Amount
(in lacs)
Pu"!ose fo"
'#ic#
"edui"ed
Secu"it% Offe"ed
P"ima"% Secu"it% (Details
'it# a!!"o- $alue to &e
mentioned)
3#et#e" .ollate"al
Secu"it% offe"ed (Please
mention %es o" no) (If %es<
t#en !"o$ide details in
.olumn )+)
.as# ."edit 0ES 1 NO
Te"m Loan 0ES 1 NO
L.14, 0ES 1 NO
= A.TI>IT0 Eisting
P"o!osed
(?)
? If a diffe"ent acti$it% ot#e" t#an eisting acti$it% is !"o!osed
@ NAMES O* ASSO.IATE .ON.ERNS AND NAT6RE O* ASSO.IATIONA
)B Relations#i! !f P"o!"ieto"1Pa"tne"1Di"ecto"
'it# t#e officials of t#e 4an(1Di"ecto" of t#e 4an(
)B(a) .REDIT *A.ILITIES (ECISTIN,) (Rs- in lacs)
)B(&) It is ce"tified t#at ou" unit #as not a$ailed an% loan f"om an% ot#e" 4an(1 *inancial
Institution in t#e !ast and I am not inde&ted to an% ot#e" 4an(1 *inancial Institution ot#e"
t#an t#ose mentioned in )B(a) a&o$e-
)) .REDIT *A.ILITIES (PROPOSED)A
In case of te"m loan "eDui"ements< t#e details of mac#ine"% ma% &e gi$en as unde"A
Past Pe"fo"mance1 *utu"e Estimates (Actual !e"fo"mance fo" t'o !"e$ious %ea"s< estimates
fo" cu""ent %ea" and !"oEection fo" net %ea" to &e !"o$ided fo" 'o"(ing ca!ital facilities-
Ho'e$e" fo" te"m loan facilities< !"oEections to &e !"o$ided till t#e !"o!osed %ea" of
"e!a%ment of loan)A
(Rs in lacs)
PAST 0EAR7II
(Actual)
PAST 0EAR7I
(Actual)
PRESENT 0EAR
(Estimates)
NECT 0EAR
(P"oEection)
Net Sales
Net P"ofit
.a!ital (Net
'o"t# in case
of com!anies)
Statuto"% O&ligation 3#et#e"
com!lied 'it#
(3"ite 0es1No)-
If not a!!lica&le<
t#en '"ite N-A-
Rema"(s (An% details in
connection 'it# t#e "ele$ant
o&ligation to &e gi$en)
)- Regist"ation unde" S#o!s and Estd Act
+- Regist"ation unde" SSI (P"o$isional1
*inal)
/- D"ug License
2- Latest Sales ta "etu"n filed
5- Latest Income ta "etu"n filed
8- An% ot#e" statuto"% dues "emaining
outstanding
Type of
machine
Purpose for
which
required
Whether
imported or
indigenous
Name of
supplier
Total cost of
machine (in case
of imported
machine, the
breakup of basic
cost, freight,
insurance and
customs duty be
given)
Contribution
being made by
the promoters
Loan
required
)+- Details of .ollate"al Secu"it% offe"ed< if an%< including /
"d
!a"t% gua"antee F
(F As !e" R4I guidelines< &an(s a"e not to ta(e collate"al secu"it% fo" loans u!to Rs- 5 la(#s to
MSME units)
)/
)2 Status "ega"ding Statuto"% O&ligationsA
SPA.E *OR PHOTO SPA.E *OR PHOTO SPA.E *OR PHOTO
Signatu"es of P"o!"ieto"1 Pa"tne"1 Di"ecto" '#ose !#oto is affied a&o$e
Onl% one !#oto of !"o!e"ito" 1 eac# Pa"tne" 1 Eac# 'o"(ing Di"ecto" is "eDui"ed to &e
affied- Eac# !#oto 'ill &e ce"tified1attested &% t#e 4"anc# Team 'it# name and
signatu"es on t#e !#otog"a!# 'it# 4"anc# stam!- T#e conce"ned staff 'ill !ut #is name
&elo' t#e signatu"es-
)5
)8 DateA PlaceA
I13e ce"tif% t#at all info"mation fu"nis#ed &% me1us is t"ueG t#at I13e #a$e no &o""o'ing
a""angements fo" t#e unit ece!t as indicated in t#e a!!licationG t#at t#e"e is no o$e"dues1statuto"%
dues against me1us1!"omote"s ece!t as indicated in t#e a!!licationG t#at no legal action #as
&een1is &eing ta(en against me1us1!"omote"sG t#at I13e s#all fu"nis# all ot#e" info"mation t#at ma%
&e "eDui"ed &% %ou in connection 'it# m%1ou" a!!lication t#at t#is ma% also &e ec#anged &% %ou
'it# an% agenc% %ou ma% deemed fit and %ou< %ou" "e!"esentati$es< "e!"esentati$es of t#e Rese"$e
4an( of India o" an% ot#e" agenc% as aut#o"ised &% %ou< ma%< at an% time< ins!ect1$e"if% m%1ou"
assets< &oo(s of account etc- in ou" facto"%1&usiness !"emises as gi$en a&o$e-
ANNEXURE-# - $%n%ral &nor!ation (Application or!"
APPLICATION FORM

A. GENERAL INFORMATION :

1. Name:
2. Address: (furnish details of branches, if any)



3. Constitution:
(Partnership / Proprietorship/Joint Hindu Family/Co-operatie !o"iety/ Pu#li"
$imited Company/Priate $imited Company et".%
4. Date of establishment:
5. Names and addresses of Partners/ Directors etc.:

Name Address





























6. Brief details of business exerience of ersons mana!in! the business:



". Nature of business:
#. Names of associate concerns and nature of association $i.e. common
artner, subsidiary etc.):

Names of associate Concerns Nature of Association Extent of Interest







B. PROPOSAL:

%. Nature of facilities sou!ht: (Please indi"ate separately the types o& &a"ilities
re'uired( i.e. )hether term loan or )or*in+ "apital adan"e i.e. "ash "redit/#ill
&a"ilities/ "lean oerdra&t et".%
S. No. T!"e of faciit! Amount






&'. Purose of the ad(ance: (,n "ase o& )or*in+ "apital adan"e( please state )ith
reasons )hether the adan"e is re'uired (a% &or adan"e payment to suppliers- (#% &or
"arryin+ hi+her sto"*s- ("% &or e.tension o& hi+her "redit on sales- (d% to repay sundry
"reditors &or pur"hases- (e% &or repayment o& #orro)in+s &rom other #an*s/&inan"ial
institutions- (&% &or repayment o& other outside #orro)in+s e.+. a+ainst hundies et".- (+%
)ithdra)al o& "apital- (h% inestment else)here- (i% any other purpose%.





&&. $a) )xistin! arran!ements from other ban*s/financial institutions and others:
$+mount in ,s. )
Name of the Ban* or Nature of Position of accounts as -ecurity, rates of
.inancial /nstitution
facility on
0 0 /0 0 /0 0
interest,
reayment terms,
if any
1imits 2utstandin!
s











&&. $b) 2ther borro3in!s/liabilities:

Source Amount Securit! Terms of re"a!ment# if
an!





&&. $c) +re you a!reeable to deal exclusi(ely 3ith us4 /f not, lease !i(e reasons:





&5. -ecurity offered:
$a) -toc*, bills etc.
(Please +ie #rie& details o& sto"*s- also( )hat )ould #e the types o& #ills(
)hether they )ould #e "lean or )ould #e a""ompanied #y do"uments( i.e.(
/./s.( motor tru"* re"eipts( et". ,& #ills "annot #e dra)n( please indi"ate reasons
there&or%.


$b) 6ort!a!e of immo(able roerties:
(Please indi"ate #rie& details o& the properties o&&ered( in )hose names they
stand( nature o& mort+a+e( estimated mar*et alue( prior "har+es( i& any%.




$c) 1ife /nsurance Policies, -hares, Debentures, etc.:
(Please +ie details o& the se"urity( surrender/mar*et alue( et".%




$d) 7uarantee:
(Please indi"ate #rie& details a#out the +uarantor( his )orth( et".%



C. FINANCIAL & OPERATIONAL DATA :

&8. Performance : $'''9s omitted)
+ctuals for last
year
)stimates for
current year
Pro:ections for
next year
Purchase


-ale
Net rofit
&4. Plans and Prosects: (Please indi"ate plans &or e.pansion( diersi&i"ation( et". i&
any and prospe"ts &or the ne.t year%





&5. Position re!ardin! /ncome;tax +ssessment:
(Please indi"ate the year up to )hi"h assessment has #een "ompleted. ,&
assessment is in arrears( reasons there&or( amount o& arrears o& in"ome-ta.( i&
any( and proision made there&or. Please atta"h "opy o& latest
assessment/return.%



&6. Position re!ardin! -ales;tax:
(,& there are arrears( these may please #e indi"ated. Please atta"h "opy o& latest
assessment return%.





&". Position re!ardin! <ealth;tax:
(,& you are a )ealth-ta. payer( please atta"h a "opy o& the re"ent de"laration and
indi"ate position re+ardin+ assessment.%




&#. .inancial osition of the Prorietor/each Partner/ each member of =>. :
(0o #e &urnished in the "ase o& proprietorship "on"erns partnership &irms/1oint
Hindu &amily (JHF% "on"erns respe"tiely.%

$a) Particulars of immo(able roerties
Name of the
indi(idual
Nature of
immo(able
roerties
1ocation )stimated
(alue
$'''9s omitted)
Prior char!es,
if any





$b) Particulars of mo(able assets
Name of the
indi(idual
Brief details of
mo(able assets
e.!., share, units,
securities, etc.
6ar*et/surrender
(alue $'''9s
omitted)
Prior char!es, if
any





$c) Particulars of borro3in!s/ liabilities, if any.
Name of the
indi(idual
-ource +mount in
,s.
-ecurity ?erms of
reayment, if
any







Place.......................
Date........................ -i!nature of +licant


NOTE:$

$&) 0his appli"ation &orm should #e a""ompanied #y t)o "opies o& the audited
#alan"e sheets and pro&it and loss a""ount )hi"h are not more than 12 months
old. (,n "ase a""ounts are not audited( statements o& assets and lia#ilities and
supplementary in&ormation as per pro&orma Anne.ure-2 should #e &urnished%. ,n
"ase o& ne) "onne"tion( *indly su#mit the audited #alan"e sheets and pro&it and
loss a""ounts (or in the alternatie( statements as per pro&orma Anne.ure-2% &or
the last three years.
$5) Please &ill in Appendi. -A and/or - 3( i& the appli"ation is &or a )or*in+ "apital
adan"e and/or term loan.
$8) Please atta"h t)o "opies o& Partnership 2eed/3ye-la)s / 4emorandum and
Arti"les o& Asso"iation in "ase o& ne) "onne"tion or "han+e in the "onstitution o&
partnership &irm/ "o-operatie so"iety / 1oint-sto"* "ompany.

+PP)ND/@;+

(This form is to be compete! o"# $he" $or%i"& c'pit' fi"'"ce is re()ire!*


Name of t%e unit: .....................................................

&. P+RC,ASES:
$a) 7eneral: (Please indi"ate )ho are the ma1or suppliers( )hether the +oods
are su#1e"t to any 'uota/ pri"e "ontrol/ 5oernment re+ulation( )hether there are
any spe"ial pro#lems inoled in ma*in+ pur"hases%.



$b) ?erms of urchases:

+d(ance ayment, if any,
reAuired to be made:

Period and amount of
credit a(ailable:


$c) ?rend of credit recei(ed: $'''9s omitted)
+ctuals for last t3o
years
)stimates for
current year
Pro:ection
for next
year 5'0 0 / 0
0
5'0 0/0 0
+(era!e credit recei(ed
6aximum credit
recei(ed$B)

6inimum credit
recei(ed$B)



5. SALES:
$a) 7eneral: (Please indi"ate )ho are the ma1or #uyers or nature o& "lass o&
"lientele- )hether the +oods are su#1e"t to any 'uota/ pri"e "ontrol/ 5oernment
re+ulations- a&ter sales seri"e arran+ements( )here ne"essary and )hether
there are any spe"ial pro#lems inoled in e&&e"tin+ sales.%



$b) ?erms of sales:
Percenta!e of credit sales to total
sales:


?erms of Credit:
(Please indi"ate period o& "redit(
dis"ounts
i& any( o&&ered &or "ash sales or earlier
payments &or "redit sales%




$c) ?rend of credit !i(en: $'''9s omitted)

+ctuals for last t3o
years
)stimates for
current year
Pro:ection
for next
year 5'0 0 / 0
0
5'0 0/0 0
+(era!e credit !i(en
6aximum credit !i(en $B)
6inimum credit !i(en $B)

8. STOC-S POSITION: (Please indi"ate 'uantity and alue #oth )hereer
possi#le.)
$'''9s omitted)
+ctuals for last t3o
years
)stimates for
current year
Pro:ection
for next
year 5'0 0 / 0
0
5'0 0/0 0
+(era!e stoc*s carried
6aximum stoc*s carried
$B)

6inimum stoc*s carried
$B)


6. STORA.E: (Please indi"ate ho) the +oods are stored. )hether ade'uate
stora+e spa"e is aaila#le( )hat portion o& +oods "an #e *ept under 3an*7s lo"*
and *ey( )hat portion is re'uired &or display and day-to-day operations( period o&
)hi"h sto"*s "an #e stored sa&ely and spe"ial pre"autions( i& any( re'uired to #e
ta*en &or stora+e o& sto"*.%
Place................................
Date................................. -i!nature of +licant


(8% 2ata in re+ard to ma.imum and/or minimum should #e +ien )here( the aera+e
di&&ers su#stantially &rom the ma.imum and/or minimum due to seasonal or other
&a"tors.
A""endix &
'T%is form is to (e com"eted on! )%en a term oan is re*uired+
Name o& the 9nit:
1. Cost o& the !"heme
Cost already met Cost to #e met 0otal Cost 3asis o& the
Cost :stimate
$and
3uildin+
:'uipments
(Please
indi"ate
nature o&
e'uipment%
;thers
(Please
spe"i&y%
Tota
2. Correspondin+ !our"es o& Finan"e
Cost already met Cost to #e met 0otal "ost
;)n resour"es
3orro)in+ &rom
&riends( relaties
et"
3orro)in+ &rom
3an*
2e&erred
payment
;thers (Please
spe"i&y%
Tota
3. Need &or the Proposed Capital :.penditure
(Please indi"ate the #a"*+round o& the s"heme i<( )hy it is ta*en up and )hat
#ene&its a""rue there&rom%
6. 0ime !"hedule:
(4ention )hen s"heme is to #e "ompleted%
=. 4ode o& 2is#ursement:
(>hether the loan is re'uired in lump sum or in instalments and i& in instalments(
please indi"ate the dates and amounts o& )ithdra)als%
?. i. Pro&itat#ility:
@ear 2A---/-- 2A--/-- 2A--/-- 2A--/--
!ales
;ther in"ome
0otal (A%
:.penses
Pur"hases
!alaries B
allo)an"es
;ther
esta#lishment
e.penses
,nsuran"e
/ent and ta.es
Adertisement
and pu#li"ity
!tationary
0raellin+
e.penses
;ther
e.penses
(Please +ie
details o& ma1or
items%
2epre"iation
,nterest
0otal (3%
Net Pro&it (A-3%
$ess: ,n"ome
ta.
Net Pro&it a&ter
ta. (C%
Add #a"*
depre"iation
(2%
0otal "ash
a""ruals (CC2%
/epayment o&
loan
Note: ,n "ase the "apital e.penditure pro+ramme as )ell as plans &or raisin+ &unds to
meet the e.penditure e.tends oer a period o& 2 to 3 years( a "ash &lo) &ore"ast
statement as in item ?. (ii% +ien #elo) should #e &urnished( other)ise statement ? (i%
+ien a#oe )ould #e su&&i"ient.
?. ii. Cash Flo) Fore"ast: (0he statement should "oer the entire period o& the loan
and re'uires to #e "ompleted only i& the "apital e.penditure pro+ramme as )ell as
plans &or raisin+ &unds to meet e.penditure e.tends oer a period o& 2/3 years or
more%
a. !our"es o& Funds:
@ear 2A---/-- 2A--/-- 2A--/-- 2A--/--
1. Net Pro&it a&ter
ta.es (,tem (C% a#oe%
2. Add: #a"*
depre"iation
3. 0otal "ash a""rual:
(1C2%
6. ,n"rease in "apital
=. ,n"rease in terms
loans and de&erred
payment +uarantee
?. ,n"rease in "urrent
lia#ilities
D. ,n"rease in short
term #an*
#orro)in+
E. ,n"rease in loans
and deposits &rom
&riends and
relaties(
su#sidiaries( et".
F. 2e"rease in &i.ed
assets
1A. 2e"rease in sto"*s
11. 2e"rease in #oo*
de#ts
12. 2e"rease in other
"urrent assets
13. 2e"rease in
inestments in
asso"iate
"on"erns
16. ;ther (Please
spe"i&y%
1=. 0otal
(#% 9ses o& &unds
1?. /epayment o&
term loans
1D. /epayment o&
instalments on
de&erred
payments
1E. ,n"rease in &i.ed
assets
1F. 2e"rease in
"urrent lia#ilities
2A. ,n"rease in #oo*
de#ts
21. ,n"rease in
sto"*s
22. ,n"rease in
inestments in
asso"iate
"on"erns
23. /epayment o&
deposits/loan
26. 2iidends or
&unds re'uired
&or personal
maintenan"e
2=. Any other
(Please spe"i&y%
2?. 0otal
2D. !urplus (1=-2?%
D. /epayment !"hedule: (Please indi"ate as to ho) you intend to repay the loan%
E. !e"urity o&&ered:
(Please +ie details o& the se"urity you propose to +ie to the #an* and details o& the
e.istin+ "har+es thereon( i& any%
F. >or*in+ Capital:
(Please indi"ate here the details o& your )or*in+ "apital re'uirement and the sour"es
&rom )hi"h they #e met%
Pla"e
2ate !i+nature o& Appli"ant