Vidya Lakshmi Common Education Loan Application Form

Student ID 1176443

Application ID 548410

Bank Name Bank of Maharashtra

Bank Scheme Name MODEL EDUCATIONAL LOAN SCHEME

Preferred Bank IFSC Code MAHB0001183

Preferred Bank Branch Name GOLAKA MANDIR BRANCH GWALIOR

Date of Application 19-Jul-2019

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mr.

First Name RAJEEV NIRPAL

Middle Name SINGH SINGH

Last Name TOMAR TOMAR

Father’s /Husband’s First Name NIRPAL RAJENDRA

Father’s /Husband’s Middle Name SINGH SINGH

Father’s /Husband’s Last Name TOMAR TOMAR

Date of Birth 23/08/1997 01/07/1976

Category Others Others

Sex Male Male

Marital Status Single Married

BBA COURSE FROM AMITY

Educational Qualification
UNIVERSITY

Marks obtained in Highest

69.5 0.0 0.0
qualification %

Occupation Student Business

Income from all sources (Rs) 250000.00

PAN No.# BSVPT0954L AETPT5682G

State Madhya Pradesh Madhya Pradesh

Address Line 1 LIG-60, SHATABDIPURAM LIG-60, SHATABDIPURAM

Address Line 2 DEENDAYAL NAGAR, GWALIOR DEENDAYAL NAGAR, GWALIOR

Village / Area/ Locality GWALIOR GWALIOR

Block/Taluka /Sub-district/Town Gwalior Gwalior

PIN 474020 474020

Contact No. 9685149147 9644156648

e-mail Id rajeevtomar1997@gmail.com nirpalsingh780@gmail.com

Present Banker Details

Branch IFSC SBIN0010536 MAHB0001183

Banker STATE BANK OF INDIA Bank of Maharashtra

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 MADHAV INSTITUTE OF
GOLAKA MANDIR BRANCH
Bank Branch TECHNOLOGY & SCIENCE
GWALIOR
(MITS) GW

Account Type Savings Account Current Account

SB / OD A/c No. 34605410996 60030726971

Direct/Indirect liability details (Rs) NONE NONE

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. No

If yes, details of relationship

3. Particulars of course, for which loan is required.

Whether under: Merit / Management Quota Merit

Name of the Institution DNYANSAGAR INSTITUTE OF MANAGEMENT & RESEARCH

Name of the Course MBA

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 27/07/2019 Date of Completion

Cost of Finance Details

4. Cost of Course / Source of Finance: (All amounts are in (Rs))

Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total

Tuition fees 100000 0 100000.00

Exam fees 75000 0 75000.00

Books Stationery 35500 19500 55000.00

Equipment/Computer 20000 0 20000.00

Hostel Expenses 0 0

Sundries/Travel 0 0

TOTAL 230500 19500 250000.00

Own Source / Scholarship 0 0

Loan Required 230500 19500 250000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

No. of Installments Amount (Rs) p.m.

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

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I / We declare that all the particulars and information given in the application form are true, correct and complete and binding on me / us. Further,
the above particulars shall form the basis of any loan Bank may decide to sanction to me / us. The loan amount will be used for the purpose for
which it is granted.

Signature of the Signature of the Signature of the

Student Parent/Guardian Co-obligant/Guarantor

Place:

Date:

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For office use

Credit Report No. Date : Customer ID/Application ID:

Details of security including

Rate of Repayment Whether eligible under CSIS
Nature of limit Amount (Rs.) Margin(Rs.) Personal Guarantee/Co-
Interest* conditions Scheme / (Yes/No)
obligation.

Other terms and conditions:

The Bank may revoke in part or in full or withdraw/stop financial assistance at any stage by giving reasonable notice to the borrower. Credit
facilities sanctioned are to be availed within 6 months from the date of this letter, failing which; the limits will automatically stand cancelled.

Manager/Senior Manager / Accepted all the terms and

Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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