BOTH TL AND WC APPLICATION

All Dates should be in dd/MM/yyyy format
Fields marked as * are mandatory
Application Details
* Bank / Institution Reference No.
* Bank / Institution Branch Name
Bank / Institution Branch Code

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Borrower Details
Whether borrower already assisted by bank
Outstanding Amount on date of sanction of
credit Facility
NPA
Whether Borrower Covered by CGTSI
previously
None
* Constitution
* Borrower / Unit Name

Yes
No
.................................... in Rs.
Yes

No

Yes

No

Borrower ID
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* Unit Address
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*District:
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* PIN code
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ITPAN of Firm
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Nature of Industry
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*Type of Activity
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Projected Optimum Sales Turnover ........................... in Rs.

CGPAN

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* State:

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*City

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SSI Registration Number
Industry Sector:
Number of Employees
Projected Optimum Exports

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............................in Rs.

1

............................................... .............................. Date of Birth .............................................................................. sanction of facility) 4... Name .................... Project Details....... sanction of facility) 3.................................................................... ..... Name .................. 2 ......................... ..... ITPAN of Chief Promoter ........ Name Net Worth(as on date of ................. hypothecation of jewellery... ......... mortgage of house.............................................. ....................................................................... ............... Name Net Worth(as on date of ............ .....................Promoter Details Chief Promoter's Information * Title * First Name Middle Name Name * Gender ... sanction of facility) 2................................ Social Category Legal ID Name ................................................. Other Partners / Promoter Directors * Last Name (Surname) ........................ 1.............................................. etc........ Name Net Worth(as on date of ... ITPAN ... sanction of facility) Name of Subsidy / Equity Support Scheme ............................ 3.......................... it is considered as Third Party Guarantee............ Male Female Date of Birth .. # When the borrower furnishes the guarantee of any other person / corporate not connected with the project..................................... 2.................. Name ................... ITPAN ............................... ITPAN ......... Guarantors 1....................... For example... Value ............ Name Net Worth(as on date of .................... Date of Birth ..................... Date of Birth ..Outlay * Collateral Security Taken # Third Party Guarantee Y N Y N * Collateral security is any other security offered for the said loan.........

................ ............... 3 ........ Non Fund Based ....... ....... in Rs....................................... in Rs.......... Amount Disbursed * Tenure (months) ................................................................................ in Rs................ Others ...................... * Date of Sanction Date of first disbursement if already made Date of last and final disbursement if already made ........ . Other Fixed / Movable Assets . Promoters Contribution ......Primary Security Details Security Name Particulars Value(in Rs...... in Rs......................................................................................... in Rs.................................... * Credit to be Guaranteed .............. --> Whether provided as margin Yes No money under Term Loan Promoters Contribution ........... Working Capital Assessed ........... in Rs... BO N Term Credit Details Amount Sanctioned in Rs........................... .... Project Cost ............... Others ....... in Rs............ Subsidy / Equity Support ................. in Rs........................ Plant and Machinery ........... Building ................................ .. Current Assets .......... FacilityDetails Scheme Loan Type Composite Loan . Project Outlay * Working Capital Limit Sanctioned Fund Based ..... .......... Subsidy / Equity Support ...................................................... ........... ......... Means Of Finance Term Credit Sanctioned ...................................... in Rs...............................) Land . ...... ....................... in Rs.... in Rs...................................... Others ............................................ in Rs.............................. Total in Rs.............................................................. in Rs......

4 .