Annexure-1

To be filled by Kendra Manager

Form No. A (Checklist A)

1. Kendra name and no.

2. Group no.
3. Name of the member
4. Area no.

Check Points

1. Whether a minimum of 4 loan cycles have been completed by Member (Name

mentioned above) Yes / No
2. Whether the attendance of member in Kendra meetings is more than 95.00%
Yes /
No
3. Has the member defaulted in the previous loan utilisation cycle anytime (utilised
loan for other than stated purpose) Yes / No
4. Whether the average voluntary savings of the member has ever been less than Rs
50 after completion of first year. (Purpose: Do members save in Voluntary savings
after obtaining loan from Grameen Koota) Yes / No
5. Is there any case of irregularity in the loan repayment in past loan cycles
(Exception: Case of natural calamity for the whole Kendra) Yes / No
6. Whether the member or her husband has a previous history of migrating to other
districts or states for employment for more than 3 months in previous loan cycles.
Yes /
No
7. Is there any case where the member has absented herself without intimating her
fellow group members Yes / No

Result:
If the answer of Question no. 1 and 2 is YES and answer to Question no. 3 to 7 is NO, the
member is recommended for form B.

Member is recommended for form B: Recommended / Not recommended

Remarks:

Signature:
Name of Kendra Manager:
Date:
Annexure-2
To be filled by Kendra Manager
Form B

1. Kendra name and no.

2. Group no.
3. Name of the member
4. Area no.
5. Activity in which Member is involved

Unit of Analysis: Individual/Household

1. No. of members in family
2. Family profile:

S No. Member Name Age Occupation Annual Earnings

(Rs.)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Any other source of income (If yes, please
specify earnings)
i. Total Household Income

ii. Household Income before joining Grameen Koota (from MBDF) Rs._________

iii. Increase in Income: Rs.__________

3. Household Expenditure (Annually)

S No. Particular Expenditure (Rs.)

1. Food
2. Housing
3. Clothing
4. Sanitation
5. Education
6. Religious/social functions
7. Others
Total household
Expenditure
 4. Assets Increase in last loan cycles (Increase in Capital Base):
Please Tick the appropriate option
i. Land/ House
0) Not invested
1) Less Rs5,000 invested
2) Between Rs.5,000 to Rs10,000 invested
3) Between Rs.10000 to Rs25000 invested
4) over Rs25000 invested

ii. Animal
0) Not invested
1) Less Rs2,000 invested
2) Between Rs.2,000 to Rs5,000 invested
3) Between Rs.5,000 to Rs10,000 invested
4) Over Rs10,000 invested,

iii. Jewellery
0) Not invested
1) Less Rs2,000 invested
2) Between Rs.2,000 to Rs5,000 invested
3) Between Rs.5,000 to Rs10,000 invested
4) Over Rs10,000 invested,

iv. Movable Asset

0) Not invested
1) Bicycle/Pulling Cart
2) Moped
3) Old Scooter/Motorcycle/Auto
4) New Scooter/Motorcycle/Auto

v. Cash/Bank
0) Not invested
1) Less Rs5,000 invested
2) Between Rs.5,000 to Rs10,000 invested
3) Between Rs.10000 to Rs25000 invested
4) over Rs25000 invested

vi. Amount spent in Marriage

0) Not invested
1) Less Rs5,000 invested
2) Between Rs.5,000 to Rs10,000 invested
3) Between Rs.10000 to Rs25000 invested
4) Over Rs25000 invested
vii. Other Savings (like chit fund)
0) Not invested
1) Less Rs5,000 invested
2) Between Rs.5,000 to Rs10,000 invested
3) Between Rs.10000 to Rs25000 invested
4) Over Rs25000 invested

5. Social Indicators:
Please, Fill the boxes 1, 2 or 3 appropriately

S Indicators Before Presently

No. joining GK
1. Education of the children (3-all going to school, 2-
atleast one but not all going to school, 1-none going
to school)
2. Family Planning (3-Having less than two children, 2-
Having three or four children ,1-Having more than
four children)
3. Member’s participates in discussions on problems at
Kendra meeting (3-Regularly, 2-Occasionally,
1-Never)
4. Member’s participation in social and political
activities like electoral/functions etc. (3-cast vote
regularly, 2- cast vote occasionally, 1- do not cast
vote)
5. Insurance (3- Taken both Member’s life and cattle
insurance, 2- Taken any of Member’s life or cattle
insurance, 1- None of Member’s life and cattle
insurance)
6. Any other Debt (3-No Debt, 2-Debt Amount less than
Rs.10,000, 1-Debt Amount more than Rs.10,000
Total

Change in Member’s Social Status {plus (+) change in indicator represents

increase in social status, Negative (-) change in indicator represents
decrease in social status}

Change in member social status

 6. Standard of living:
Please, Fill the boxes 1, 2 or 3 appropriately

S. Indicators Before Presently

No. joining GK
1. Electricity (3-yes, 2-Shared,1-No)
2. Water Supply (3-Own,2- Nearby community
Tap/Well,1-Fetching from nearby village)
3. Toilet (3-pit, 2-Flush,1-Open Area)
4. Cooking (3-Gas, 2-Kerosin Oil, 1-Wood/others)
5. Radio/ T.V.(3-TV, 2-Radio, 1-None)
Total

Change in Member’s Standard of living {plus (+) change in indicator

represents increase in social status, Negative (-) change in indicator
represents decrease in social status}

Change in Member’s Standard of living

Remarks:

Signature:

Name of Kendra Manager:

Date:

_______________________________________________________________________
_
To be filled by Branch Manager To be filled by Area Manager
Remarks: Remarks:

Signature: Signature:
Name of Branch Manager: Name of Area Manager:
Date: Date:
Annexure-3
Confidential
Calculation Sheet for STAR BORROWER
To be filled by Operation Manager
1) Kendra name and no.
2) Group no.
3) Name of the member
4) Area no.

Complete the calculations as follows:

Change in income (2-iii)

Increase in income = ----------------------------------------------------------------------X 100
Household Income before joining GK (from MBDF)(2-ii)

=________ %

A) Increase in Income (Tick the point appropriately as per above Calculation):

0) increase in income less than 10% or decrease in income

1) increase in income between 10% to 20%
2) increase in income between 21 %over 50%
3) increase in income between 51% and 75%
4) increase in income between 76% and 99%
5) increase in income over 100%

Annual Savings at the household level =

Total annual Household Income (2-i) - Annual household expenditure (3)

B) Annual Savings at the household level (Tick the point appropriately as per above
Calculation):

0) No Saving or Deficit
1) Less Rs2,000 saving
2) Between Rs.2,000 to Rs5,000 saving
3) Between Rs.5,000 to Rs10,000 saving
4) Over Rs10,000 saving
SCORE SHEET

S. No. Parameter Scale Multiplicati Points Maximum

Ticked on Factor Obtained points
A Increase in Income 5.00 25.00
(Between 0 to 5)
B Annual Savings at the 2.00 8.00
household level
(Between 0 to 4)
4-I Land/House 1.50 6.00
(Between 0 to 4)
Ii Animal 0.66 2.66
(Between 0 to 4)
Iii Jewellery 0.66 2.66
(Between 0 to 4)
Iv Movable Asset 0.66 2.66
(Between 0 to 4)
V Cash 1.50 6.00
(Between 0 to 4)
Vi Amount spent in 1.50 6.00
Marriage
(Between 0 to 4)
Vii Other Savings (like chit 1.50 6.00
fund)
(Between 0 to 4)
5 Increase in social status 1.66 20.00
(Between 0 to 12)
6 Increase in Standard of 1.50 15.00
living
(Between 0 to 10)
Total Points 100.00

Result:
If the score of the member borrower is equal or greater then 45.00 then she is considered
as star borrower.
Member is considered as Star Borrower YES or NO
Remarks for the member:

Signature:
Name of Operation Manager:
Date:
 Annexure-4
Weightage
Increase in Income (multiplying factor 5) 25
0) increase in income less than 10% or decrease in income
1) increase in income between 10% to 20%
2) increase in income between 21 %over 50%
3) increase in income between 51% and 75%
4) increase in income between 76% and 99%
5) increase in income over 100%

Annual Savings at the household level (Multiplying Factor 2) 8

0) No Saving or Deficit
1) Less Rs2,000 saving
2) Between Rs.2,000 to Rs5,000 saving
3) Between Rs.5,000 to Rs10,000 saving
4) Over Rs10,000 saving

Increase in assets 32
i. Land/House (Multiplying Factor 1.50)
ii. Animal (Multiplying Factor 0.66)
iii. Jewellery (Multiplying Factor 0.66)
iv. Movable Asset (Multiplying Factor 0.66)
v. Cash (Multiplying Factor 1.50)
vi. Amount spent in Marriage (Multiplying Factor 1.50)
vii. Other Savings (like chit fund) (Multiplying Factor 1.50)

Increase in social status 20

i. Education of the children (Multiplying Factor 1.66)
ii. Family Planning (Multiplying Factor 1.66)

iii. Member’s participates in discussions on problems at Kendra meeting

(Multiplying Factor 1.66)
iv. Member’s participation in social and political activities like electoral/functions etc.
(Multiplying Factor 1.66)
v. Insurance (Multiplying Factor 1.66)
vi. Any other Debt Amount (Multiplying Factor 1.66)

Increase in Standard of living 15

i. Electricity (Multiplying Factor 1.50)
ii. Water Supply (Multiplying Factor 1.50)
iii. Toilet (Multiplying Factor 1.50)
iv. Cooking (Multiplying Factor 1.50)
v. Radio/TV (Multiplying Factor 1.50)

Total 100