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ANNEXURE A

ALLAHABAD BANK
HEAD OFFICE : 2, NETAJI SUBHAS ROAD, KOLKATA 700 001
APPLICATION FORM FOR MICRO, SMALL AND MEDIUM ENTERPRISES (MSME)
LOAN UPTO RS.100 LAKHS
(To be submitted along with documents as per the checklist)
Name of the Branch

Ref. No. Date :
1. Name of the nterprise!
". Regd. #ffice $ddress!
%. $ddress of &actor'()hop!
*hotograph to be
pasted at the
time of signing of
the application in
the designated
branch
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+. ,hether Belongs to
)-()T(#B-(.inorit'
-ommunit':
/f 0es1 then *lease )elect:
)-( )T( #B-( .inorit'
-ommunit'
0es ( No
2. Telephone No.!
3. mail $ddress!
4. .obile No.!
5. *$N -ard No.
6. -onstitution (*lease
)elect)! /ndi7idual( 8oint(
*rop. -oncern( *artnership(
*7t 9td -o( 9imited -o( Trust(
others
1:. Date of stablishment!
11. )tate !
1". -it' where loan is
re;uired!
District
1%. Branch where loan is
re;uired. (/f an')
1+. Name of *roprietors( *artners( Directors of -ompan' and Their $ddresses: !
).No Name Date of
Birth
&ather(
)pouse
$cademic
<ualification
.obile No
1.
".
%.
).No *$N No. Residential $ddress Telephone No.
(Residence)
=perience in
the line of
acti7it' (0ears)
1.
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".
%.
12. $cti7it'! =isting >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> since >>>>>>>>>

*roposed? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
?if a different acti7it' other than e=isting acti7it' is proposed.
13. Names of $ssociate -oncerns and Nature of $ssociation:
Name of
$ssociate
-oncerns
$ddress of
$ssociate
-oncerns
*resentl'
Banking ,ith
Nature of
$ssociation
=tent of
/nterest as a
*rop.( *artner(
Director or 8ust
/n7estor in
$ssociate
-oncern
Relationship of *roprietors( *artners( Directors with the officials of the Bank( Director of
the Bank: *lease select (0es( No) >>>>>
14. Banking(-redit &acilities (=isting) (Rs. in lakh)
T'pe of
&acilities
9imit in
9akh
#utstanding
as on
*resentl'
Banking
with
)ecurities Rate of
/nterest
Repa'ment
Terms
-urrent
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$ccount
-ash
-redit
Term
9oan
9-(B@
#thers
Total
/f banking with our Bank1 customer /D be gi7en here: >>>>>>>>>>
/t is certified that our unit has not a7ailed an' loan from an' other Bank ( &inancial
/nstitution in the past and / am not indebted to an' other Bank ( &inancial /nstitution
other than those mentioned in column no. 14 abo7e.
15. -redit &acilities (*roposed)!
T'pe of
&acilities
$mount
(in lakh)
*urpose for
which
Re;uired
)ecurit' #ffered
*rimar' )ecurit'(Details
with appro=. 7alue to be
mentioned)
,hether
-ollateral )ecurit'
#ffered (/f1 'es1
then pro7ide
details on column
":)
(0es( No)
-ash -redit!!
Term 9oan
9-(B@
#thers
Total
!.andator' &ields
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!!Basis of -ash -redit 9imit applied
C!"
C#$%&'
P#()$*'$%
S+$! ,(#-&./
C0*+$ &.
1(.'"!
I.2$.'(#0 D$3'(#! C#$%&'(#
!
O'"$#
*4##$.'
!!$'!
P#(1('$#!
C(.'#&34'&(.
16. /n case of term loan re;uirements1 the details of machiner' ma' be gi7en as under:
T'pe of
.achine(
;uipment
*urpose
for which
Re;uired
,hether
/mported
or
/ndigenous
Name of
)upplier
Total -ost
of .achine
( in case of
imported
machine1
the
breakup of
basic
costs1
freight1
insurance
and
customs
dut' ma'
be gi7en)
-ontribution
being made
b' the
promoters
9oan
Re;uired
":. Details of -ollateral )ecurities #ffered1 if an'1 including third part' guarantee
(As per RBI guidelines banks are not to take collateral security for loans upto Rs.
10 Lakhs to MSM !nits"
a) Third *art' @uarantee :
).No Name of Residential Telephone .obile No Net *$N No
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@uarantor $ddress No.
(Residence
)
worth
(Rs. in
lakh)
1.
".
%.
b) #ther -ollateral )ecurit':
).No Name of owner of
-ollateral
-ollateral )ecurit'
Nature Details Aalue (Rs. in
lakh)
1.
".
%.
"1. *ast *erformance ( &uture stimates
*ast *erformance ( &uture stimates ($ctual performance for two pre7ious 'ears1
estimates for current 'ear and proBections for ne=t 'ear to be pro7ided for working
capital facilities. Cowe7er for term loan facilities proBections to be pro7ided till the
proposed 'ear of repa'ment of loan)
Rs. in lakh *ast 0ear 1
($ctual)
*ast 0ear "
($ctual)
*resent 0ear
(stimate)
Ne=t 0ear
(*roBection)
Net )ales
Net *rofit
-apital (Net
,orth in case
of -ompanies)
"". )tatus Regarding )tatutor' #bligations:
)tatutor' #bligation: Remarks( $n' details in -onnection with the rele7ant obligation to
be gi7en)
,hether -omplied with (select 0es (No). /f not applicable then select N. $.
1. Registration under )hops and stablishment $-T 0es( No( N$
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". Registration under .). (*ro7isional (&inal) 0es( No( N$
%. Drug 9icense 0es( No( N$
+. 9atest )ales Ta= Return &iled 0es( No( N$
2.9atest /ncome Ta= Returns &iled 0es( No( N$
3.$n' other )tatutor' dues remaining outstanding 0es( No( N$
"". a.) /D *roof ($n' of following):
*assport( Aoter /dentit' -ard( *$N -ard( Dri7ing 9icence( 8ob -ard( $adhaar -ard(
/dentit' -ard (subBect to the satisfaction of bank)
/D *roof No. >>>>>>>>>>>>>>
b.) $ddress *roof ($n' of following:
lectricit' Bill( Telephone Bill( Bank $ccount )tatement of an' other bank( 9etter from
reputed emplo'er( 9etter from recogniDed public authorit' 7erif'ing the address of the
customer to the satisfaction of the bank( Ration -ard
$ddress *roof No:
Declaration:
/(,e hereb' certif' that all information furnished b' me(us is trueE that /(,e ha7e no
borrowing arrangements for the unit e=cept is in the applicationE that there is no o7er
dues( statutor' dues against me(us(promoters e=cept as indicated in the applicationE
that /(,e shall furnish all other information that ma' be re;uired connection with m'(our
application that this ma' also be e=changed b' 'ou with an agenc' 'ou ma' deem fit
and 'ou1 'our representati7es or Reser7e Bank of /ndia or an' other agenc' as
authorised b' 'ou1 ma' at an' time1 inspect( 7erif' m'(our assessment of account etc. in
our factor'(business premises as gi7en abo7e.
)ignature:
#o be signed at the designated branch only$
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CHECK LIST
1. *roof of /dentit' : AoterFs /D -ard ( *assport ( Dri7ing 9icense ( *$N -ard (
)ignature
". *roof of residence: Recent telephone bills1 electricit' bill1 propert' ta=
receipt (*assport ( 7oterFs /D -ard of *roprietor1 partner of Director (if a
compan')
%. *roof of business $ddress
+. $pplicant should not be defaulter in an' Bank(&./.
2. 9ast three 'ears balance sheets of the units along with income ta= ( sales ta=
returns etc. ($pplicable for all cases from Rs. " lakh and abo7e) Cowe7er1 for
cases below fund based limits of Rs. "2 lakh if audited balance sheets are not
a7ailable1 then un audited balance sheets are also acceptable as per e=tant
instructions of the bank.
3. .emorandum and articles of association of the -ompan' ( *artnership Deed of
partners etc.
4. $ssets and liabilities statement of promoters and guarantors along with latest
income ta= returns.
5. Rent $greement (if business premises on rent) and clearance from pollution
control board if applicable.
6. ))/ ( .). registration if applicable.
1:. *roBected balance sheets for the ne=t two 'ears in case of working capital limits
and for the period of the loan in case of term loan (&or all cases of Rs. " lakh and
abo7e).
11. /n case of takeo7er of ad7ances1 sanction letters of facilities being a7ailed from
e=isting bankers( &inancial /nstitutions along with detailed terms and conditions.
1". *hotocopies of lease deeds( title deeds of all the properties being offered as
primar' and collateral securities.
1%. *osition of accounts from the e=isting bankers and confirmation about the asset
being standard with them. (in case of takeo7er).
F(# C!$! ,&'" E56(!4#$ A3(2$ R!. 27 L-"!
1+. The audited balance sheets are necessar'.
12. *rofile of the unit (includes names of promoters1 other directors in the compan'1
the acti7it' being undertaken addresses of all offices and plants1 shareholding
pattern etc.
13. 9ast three 'ears balance sheets of the $ssociate ( @roup -ompanies (if an').
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14. *roBect report (for the proposed proBect if term funding is re;uired) containing
details of the machiner' to be ac;uired1 from whom to be ac;uired1 price1 names
of suppliers1 financial details like capacit' of machines1 capacit' of utiliDation
assumed1 production1 sales1 proBected profit and loss and balance sheets for the
ne=t 4 to 5 'ears till the proposed loan is to be paid1 the details of labour1 staff to
be hired1 basis of assumption of such financial details etc.
15. Re7iew of account containing month wise sales (;uantit' and 7alue both)1
production (;uantit' and 7alue)1 imported raw material (;uantit' and 7alue)1
indigenous raw material (;uantit' and 7alue)1 7alue of stocks in process1 finished
good (;uantit' and 7alue)1 debtors1 creditors1 bankFs outstanding for working
capital limits1 term loan limits1 bills discounted.
16. .anufacturing process if applicable1 maBor profile of e=ecuti7es in the compan'1
an' tieGups1 details about raw material used and their suppliers1 details about the
bu'ers1 details about maBorGcompetitors and the compan'Fs strength and
weaknesses as compared to their competitors etc.
.
(The check list is only indicative and not exhaustive and depending upon the local
requirements at different places addition could be made as per (necessity).
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