Vidya Lakshmi Common Education Loan Application Form

Student ID 1170872

Application ID 568031

Bank Name Bank of India

Bank Scheme Name BOI STAR EDUCATION LOAN SCHEME

Preferred Bank IFSC Code BKID0001466

Preferred Bank Branch Name KANKAVALI

Date of Application 02-Aug-2019

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Ms. Mr.

First Name Priyanka Mangesh

Middle Name Mangesh

Last Name Thakur Thakur

Father’s /Husband’s First Name Mangesh Narayan

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name Thakur Thakur

Date of Birth 17/04/1994 01/06/1963

Category ST ST

Sex Female Male

Marital Status Single Married

Educational Qualification Bachleors of Engineering

Marks obtained in Highest

66.5 0.0 0.0
qualification %

Occupation Student

Income from all sources (Rs) 188400.00 188400.00

PAN No.# ARIPT7684C

State Maharashtra Maharashtra

Address Line 1 HOUSE 221 HOUSE 221

Address Line 2 BANDHKAR WADI BANDHKAR WADI

Village / Area/ Locality KANKAVLI KANKAVLI

Block/Taluka /Sub-district/Town Sindhudurg Sindhudurg

PIN 416602 416602

Contact No. 9960265581 9619561751

e-mail Id thakurpriyanka171994@gmail.com aniketharekar1231@gmail.com

Present Banker Details

Branch IFSC UBIN0531669

Banker UNION BANK OF INDIA

Bank Branch CUMBALLA HILL

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Account Type Savings Account

SB / OD A/c No. 316602010071830

Direct/Indirect liability details (Rs)

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 VITA MUMBAI

Name of the Course PG-DAC

Duration of the Course 00 (Years) 06 (Months)

Date of Commencement 19/08/2019 Date of Completion 29/02/2020

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 90000 90000.00

Exam fees 0

Books Stationery 0

Equipment/Computer 0

Hostel Expenses 0

Sundries/Travel 16200 16200.00

TOTAL 106200 106200.00

Own Source / Scholarship 0

Loan Required 106200 106200.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
24 5000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Proof of Income

Applicant Photo

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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.

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Manager/Senior Manager / Accepted all the terms and
Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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