PRAGATHI SWADESHI

PRODUCER COMPANY LIMITED

(Registered under Producer Company ACT 2013)

CIN: U01403AP2015PTC096026

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LOAN APPLICATION FORM

To
The Director,
Pragathi Swadeshi Producer Company,
Vijayawada -13.

1) Name (in block letters): ...

2) Member ID: ..Tel No: ...
3) Residential Address

: .
.

4) Age: DOB Gender ....Religion

5) Aadhaar Card(UID) Number : PAN No :
6) Accounts held by the applicant with the said company :
a) SH2 A/c No.

Amount: Rs.

b) PRD A/c No.

Amount: Rs.

c) PFD A/c No.

Amount: Rs.

d) Other A/c No. Amount: Rs.

e) Other A/c No. Amount: Rs.
7) Amount of loan applied for Rs: ...(Ordinary/Emergent)
8) No. Of Installments by which it is proposed to repay the loan.Installments @ Rs./- Each.
9) Purpose for which the loan is required: ....
.......
10)

Indebtedness to any other Producer Companies and Co-Operative Society:

11)

Any Other Liability:

12)

Name Of Sureties

Designation

Account Number

a) ........

..

b) ........

..

13) Nature of Sureties such as Deposits etc:

14) Outstanding liabilities of the applicant to the Producer Company :a) As Principal borrower:
b) As surety

(1) Person or Persons ..

(2) Amount Due ..

DECLARATION

I hereby declare that all statements and replies given herein before are true in every particular
whether written by my hand or not I have carefully read the rules and regulations printed on this application form
and the registered by Memorandum of Association and Articles of Association of the Producer Company and bind
myself to abide by them and also coming in force in future. Further I hereby undertake to exclusively bank with you
and operate my account.

I hereby declare that I shall exclusively bank with you as provided under the Producer Company
ACT 2013 and shall not bank with any other bank/Societies. This Loan Application form is filled in my own hand
writing / or at my request by your staff who has filled in all the details after my instructions and the same are duly
interpreted to me/ understood by me.
Further I/We am/are offering the Guarantee of Lien my FD / RD / Daily Deposit Receipt A/C No.
which are mentioned above with the application.

Date: .

Revenue Stamp & SIGNATURE OF BORROWER

Guarantee Statement duly signed by the Guarantors

The purpose and the amount of the Loan applied for as well as the particular of my / our
indebtedness etc. are correctly stated and that I / we believe that the applicant will be able to repay the loan by
installment of Rs._________ /-per month. I / We undertake that the loan will be used for the purpose stated in the
application form. I / We hereby further declare that all the statements and information given herein the above so
far as the same are material to the contract and every particular are true whether written by my / our hand or not.
I / We hereby declare that we have carefully read the rules and regulations printed on this
application form and bind myself / ourselves to abide by the same and also coming in force in future and the
registered by Memorandum of Association and Articles of Association.
SIGNATURE OF SURETIES:

2..

(FOR OFFICE USE ONLY)

TO BE FILLED BY THE ACCOUNTS DEPARTMENT
1. Any Previous Loan Rs

if so, was it paid in time..

2. Any Current Loan Rs...

if so, the amount Rs

Date: .

SIGNATURE & SEAL OF ACCOUNT MANAGER

DECISION OF THE MANAGEMENT

1) Sanctioned or Rejected:
2) Amount Sanctioned @ Rs.
3) Sureties Accepted (Yes/No) .
4) Number Of Installments : .

@ Rs. each

DEDUCTIONS
Amount Sanctioned

Rs. :

Deductions:Less: - Previews Loans

Rs. :

Less: - Previews Loans Interest

Rs. :

Less: - Other Advances

Rs. :
_____________________

Net Amount

Date: .

Rs. : _____________________

SIGNATURE & SEAL OF DIRECTOR

Enclosures:1.
2.
3.
4.

Self attested Aadhar Card Xerox

Self attested PAN Card Xerox
2 Blank Cheques with Singed
Self attested Address Proof Xerox (Ration Card or Driving License or Voter ID Card)