ms‡hvRbx-1

‡mev wkímg~n

1| Z_¨ cÖhyw³wfwËK †mev (AvBwmwUGm) I Kg©KvÛ| †hgb- wm‡÷gm GbvjvBwmm, wWRvBb, mwjDkb wm‡÷g Dbœqb, Z_¨
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2| K…wlwfwËK Kg©KvÛ, †hgb- K…wl cY¨, km¨, djg~j I mewR cÖwµqvRvZKiY, grm¨ AvniY, grm¨ msiÿY I wecYb
BZ¨vw`
3| wbg©vY wkí I nvDwRs
4| ‣e‡`wkK Kg©ms¯’vb
5| we‡bv`b wkí
6| wRwbs G¨vÛ ‡ewjs
7| nvmcvZvj I wK¬wbK
8| wbDwK¬qvi I GbvjvBwUK¨vj †mev (†hgb- wbDwK¬qvi wPwKrmv †mev)
9| ch©Ub I †mev
10| gvbe m¤ú` Dbœqb, D”Pgv‡bi †gav I `ÿZvm¤úbœ b‡jR †mvmvBwU
11| wewfbœ ai‡bi †Uw÷s j¨ve‡iUix
12| d‡UvMÖvwd
13| †UwjKwgDwb‡Kkb
14| cwienb I †hvMv‡hvM
15| Iq¨vinvDR
16| BwÄwbqvwis KbmvjU¨vwÝ
17| wdwjs †÷kb (†c‡Uªvj cv¤ú, wm Gb wR †÷kb, Kbfvk©b †m›Uvi)
18| cÖvB‡fU Bbj¨vÛ Kb‡UBbvi wW‡cv GÛ Kb‡UBbvi †d«BU †÷kb
19| U¨vsK Uvwg©bvj
20| †PBb mycvi gv‡K©U/ kwcsgj
21| G¨vwf‡qkb mvwf©m
22| B݇cKkb GÛ †Uw÷s mvwf©m
23| AvÂwjK wdWvi †f‡mj I †Kv÷vj RvnvR PjvPj wkí
24| WªvB WwKs I RvnvR †givgZ wkí
25| gWvb©vBRW& wK¬wbs mvwf©m di nvBivBR GcvU©‡g›Um, Kgvwk©qvj wewìs
26| A‡Uv †gvevBj mvwf©wms
27| †UKwbK¨vj †fv‡Kkbvj BÝwUwUDUm
28| weÁvcb wkíLvZ I g‡Wwjs †hgb- wcÖ›U g‡Wwjs, wUwf Kgvwk©qvjm, i¨v¤ú g‡Wwjs (K¨vU IqvK/ d¨vkb)
29| gvbm¤§Z ex‡Ri Rb¨ M‡elYv Ges Dbœqb
30| AvDU‡mvwm©s Ges wmwKDwiwU mvwf©m (†emiKvwifv‡e wbivcËviÿx/ Rbej mieivn)
31| mgy`ªMvgx RvnvR PjvPj e¨emv
32| Pjw”PÎ wkí
33| wbDR †ccvi wkí
 ms‡hvRbx-2

D”P AMÖvwaKvi LvZ

1| K…wl/Lv`¨ cÖwµqvRvZKiY Ges K…wl hš¿cvwZ cÖ¯‘ZKvix wkí

2| ‣Zwi †cvkvK wkí
3| AvBwmwU/mdU&Iqvi wkí
4| Jla wkí
5| Pvgov I PvgovRvZ cY¨ wkí
6| jvBU BwÄwbqvwis wkí
7| cvU I cvURvZ wkí

AMÖvwaKvicÖvß LvZmg~n

1| cøvw÷K wkí
2| ‣e‡`wkK Kg©ms¯’vb
3| RvnvR wbg©vY wkí
4| cwi‡ekm¤§Z RvnvR cybtcÖwµqvRvZKiY wkí
5| ch©Ub wkí
6| wngvwqZ grm¨ wkí
7| †nvg †U·UvBj mvgMÖx wkí
8| bevqb‡hvM¨ kw³ (†mvjvi cvIqvi, DBÛ wgj)
9| G¨vKwUf dvg©vwmwUK¨vj Bb‡MÖwW‡q›U wkí I †iwWI dvg©vwmwUK¨vj wkí
10| †flR Jla wkí
11| †ZRw®Œq iwk¥i (wewKiY) cÖ‡qvM wkí (†hgb-cPbkxj cwjgv‡ii ¸YMZ gvb Dbœqb/Lv`¨-km¨ msiÿY/wPwKrmv mvgMÖx
RxevYygy³KiY wkí)
12| cwjgvi Drcv`b wkí
13| nvmcvZvj I wK¬wbK
14| A‡Uv‡gvevBj cÖ¯‘Z I †givgZKvix wkí
15| n¯Í I Kviæ wkí
16| we`y¨r mvkÖqx hš¿cvwZ (GjBwW, wmGdGj evj¦ Drcv`b)/ B‡j±ªwbK hš¿cvwZ wbg©vY wkí/ B‡j±ªwbK †g‡Uwi‡qj Dbœqb
17| Pv wkí
18| exR wkí
19| Ry‡qjvwi
20| †Ljbv
21| cÖmvabx I Uq‡jwUªR
22| AvMi wkí
23| AvmevecÎ wkí
24| wm‡g›U wkí
 ms‡hvRbx-3

(webvg~‡j¨ cÖ‡`q)
ZvwiLt-

e¨e¯’vcK Qwe
...................
...................
wmGgGmGgB D‡`¨v³v wn‡m‡e FY/wewb‡qvM Gi Av‡e`b|

wcÖq g‡nv`q,
Avwg/Avgiv wmGgGmGgB D‡`¨v³v wn‡m‡e Avcbvi cÖwZôv‡bi ................................. kvLv n‡Z Avgvi/Avgv‡`i cÖwZôv‡bi AbyK~‡j PjwZ
g~jab/e¨emv m¤úªmviY I hš¿cvwZ µq/Ab¨vb¨ eve` ............... gvm †gqv`x ......................... UvKvi FY/wewb‡qvM Gi Rb¨ Av‡e`b KiwQ| wb‡¤œ
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1 FY/wewb‡qvM Gi Rb¨ Av‡e`bKvix cÖwZôv‡bi e„ËvšÍ

1.1 cÖwZôv‡bi bvg t
1.2 wVKvbv (wbR¯^/fvov) t
1.3 e¨emv‡qi cÖK…wZ t wkí e¨emv †mev
1.4 gvwjKvbvi aiY t GKK gvwjKvbvaxb Askx`vwi †h․_ g~jabx
1.5 e¨emvq wewb‡qvMK…Z g~jab t
1.6 †UªW jvB‡mÝ b¤^i I †gqv` t
1.7 e¨emv ïiæi ZvwiL t
1.8 wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤^i) t
1.9 e¨vsK wnmv‡ei bvg I b¤^i t
1.10 cÖwZôv‡bi evwl©K weµq (cÖ‡hvR¨ †ÿ‡Î) t
1.11 cÖwZôv‡bi †gvU evwl©K Avq t
1.12 cÖwZôv‡bi †gvU evwl©K e¨q t
1.13 cÖwZôv‡bi ¯’vqx m¤ú` (f~wg I BgviZ e¨ZxZ) t
1.14 cÖwZôv‡b wb‡qvwRZ Rbe‡ji msL¨v t
1.15 gRy` c‡Y¨i g~j¨ t
2 Av‡e`bKvix cÖwZôv‡bi `vq
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2.2 Ab¨vb¨ t
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3.1 bvg (evsjv I Bs‡iRx) t
3.2 Rb¥ ZvwiL I ¯’vb t
3.3 wkÿvMZ †hvM¨Zv t
3.4 cÖwkÿY t
3.5 wcZvi bvg t
3.6 gvZvi bvg t
3.7 •eevwnK Ae¯’v t
3.8 ¯^vgx/¯¿xÕi bvg t
3.9 eZ©gvb wVKvbv t
3.10 ¯’vqx wVKvbv t
3.11 Ab¨vb¨ Drm n‡Z gvwmK Avq t
3.12 gvwjKvbvaxb Ab¨vb¨ cÖwZôv‡bi bvg t
3.13 wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤^i) t
3.14 RvZxq cwiPqcÎ b¤^i t
4 Av‡e`bKvixi `vq
4.1 e¨vsK/Avw_©K cÖwZôvb t
4.2 Ab¨vb¨ t
5 FY/wewb‡qvM MÖn‡Yi D‡Ïk¨
5.1 PjwZ g~jab t
5.2 e¨emv m¤úªmviY I hš¿cvwZ µq t
5.3 Ab¨vb¨ t
6 Rvgvb‡Zi weeiY (cÖ‡hvR¨ †ÿ‡Î) t
7 Rvwgb`v‡ii bvg
7.1 Rvwgb`vi m¤úwK©Z Z_¨
7.1.1 bvg (evsjv I Bs‡iRx) t
7.1.2 Rb¥ ZvwiL t

Av‡e`bKvixi ¯^vÿi I ZvwiL

Pjgvb cvZv-2
 (webvg~‡j¨ cÖ‡`q)
-2-

7.1.3 wkÿvMZ †hvM¨Zv t

7.1.4 wcZvi bvg t
7.1.5 gvZvi bvg t
7.1.6 ¯^vgx/¯¿xÕi bvg t
7.1.7 wVKvbv
7.1.7.1 eZ©gvb (‡dvb b¤^imn) t
7.1.7.2 ¯’vqx t
7.1.8 †ckv t
7.1.9 gvwmK Avq t
7.1.10 Rvwgb`v‡ii m¤ú‡`i cwigvY t
7.1.11 wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤^i) t
7.1.12 RvZxq cwiPqcÎ b¤^i t
7.1.13 e¨vsK wnmv‡ei bvg I b¤^i t
7.1.14 e¨vsK/Avw_©K cÖwZôvb n‡Z FY/wewb‡qvM t
MÖn‡Yi cwigvY
7.1.15 Ab¨vb¨ t
7.1.16 Av‡e`bKvixi mv‡_ m¤úK© t

(cÖ‡qvR‡b c„_K KvMn mshy³ Ki‡Z n‡e)

Rvwgb`v‡ii ¯^vÿi I ZvwiL

[*FY/wewb‡qvM gÄywii Rb¨ Avek¨Kxq Ab¨ †h †Kvb Z_¨, cÖgvYcÎ Ges `wjjvw` e¨vsK/Avw_©K cÖwZôv‡bi Pvwn`v Abyhvqx MÖvnK cÖ`vb
Ki‡Z eva¨ _vK‡e]

Av‡e`bKvixi ¯^vÿi I ZvwiL

 ms‡hvRbx-4
Name of the Bank/FI: Yearly CMSME Loan Disbursement Target
Target Year:
(Amount in Crore BDT)
New Enterprise Sector and Gender -wise Disbursement Target Total Loan
Cluster Rural
Financing Cottage Enterprise Micro Enterprise Small Enterprise Medium Enterprise Disbursement
Division Sub-Sector Financing Disburse-
Target
Target of the
ment
Male Female Male Female Male Female Male Female Male Female Year
Service
Dhaka Trade
Manufacturing
Service
Chattogram Trade
Manufacturing
Service
Rajshahi Trade
Manufacturing
Service
Khulna Trade
Manufacturing
Service
Barishal Trade
Manufacturing
Service
Sylhet Trade
Manufacturing
Service
Rangpur Trade
Manufacturing
Service
Mymensingh Trade
Manufacturing
Service
Total Trade
Manufacturing
Grand Total

N.B.: The shaded portion of Cottage & Medium Enterprise (Trading Sector) need not to be filled in.
 Quarterly CMSME Loan Disbursement Statement ms‡hvRbx-5
Name of the Bank/FI:
Name of the Quarter: (Amount in Crore BDT)

Outstanding Cumulative
Outstanding of Cumulative *Overdue
Outstanding Disbursement to Cumulative CMSME Disbursement of of CMSME Recovery of
CMSME Loan Cumulative CMSME Loan Cumulative Disbursement to CMSME New CMSME Rural Loans Outstanding of Disbursement of Amount of Classified Amount of CMSME
of CMSME CMSME New Rural Loans CMSME Without Without CMSME
Nature of Disbursement (Current Disbursement (January to CMSME New Enterprises Enterprises Disbursement CMSME Rural CMSME Without CMSME Loans as on End of the
Segment Sub-Sector Loan as on End Enterprises (Current Disbursement (January Collateral (Current Collateral Loans
Entrepreneurs Quarter) Current Quarter) (January to Current Quarter) Loans as on (Current Quarter) Loans as on Collateral (January to Loans as on Quarter (as per CL)
of the Quarter Quarter) to Current Quarter) Quarter) Loans as on (January to
End of the End of the Current Quarter) End of
(as per CL) End of the Current
Quarter Quarter Quarter
Quarter Quarter)
Number Amount Number Amount Number Amount Number Amount Number Amount Number Amount Number Amount Number Amount SS DF BL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Male
Manufacturing Female
Subtotal
Male
Service Female
Cottage
Subtotal
Male
Trade Female
Subtotal
Total of Cottage
Male
Manufacturing Female
Subtotal
Male
Service Female
Micro
Subtotal
Male
Trade Female
Subtotal
Total of Micro
Male
Manufacturing Female
Subtotal
Male
Service Female
Small
Subtotal
Male
Trade Female
Subtotal
Total of Small
Male
Manufacturing Female
Subtotal
Male
Service Female
Medium
Subtotal
Male
Trade Female
Subtotal
Total of Medium
Male
Total
Female
Grand Total
*Overdue Amount = Recoverable Amount - Recovery Amount
N.B. : The shaded portion of Cottage & Medium Enterprise (Trading Sector) need not to be filled in.
Other Information:
1. General Provision Kept for CMSME Loan Disbursement as per CL:
2. Banks/FIs Total Loan Disbursement Amount Excluding Staff Loan (January to Current Quarter):
3. Total Loan Outstanding Excluding Staff Loan as per CL:
4. Cumulative Recoverable Amount of CMSME Loan (January to Current Quarter): Authorized Signature
 ms‡hvRbx-6

Quarterly Statement on CMSME Cluster Financing

Name of the Bank/FI:

Name of the Quarter:
(Amount in Lac BDT)
No. of Disbursement (Current Quarter) As on end of the Quarter Amount
Segment Borrower Cluster Recovered in
Number of
Financed Amount Outstanding Recoverable Current Quarter
Enterprise
Male
Cottage
Female
Sub Total
Male
Micro
Female
Sub Total
Male
Small
Female
Sub Total
Male
Medium
Female
Sub Total
Total
Please mention the name and location(Union/Upazila/District) of clusters:
 ms‡hvRbx-7

Statement Related to Select, Train and Provide Loan Facility to New Women Entrepreneur

Name of the Bank/FI:

Name of the Quarter:

Select, Train and Provide Loan Facility to New Women Selecting, Training and Providing Loan Facility to New Women
Entrepreneur in Current Quarter Entrepreneur in Current Year (Accumulated)
No. of Total No. of No. of Disbursed Credit No. of No. of Disbursed Loan
Branch Branches Selected and Branches Selected and
Providing Trained No. of Amount Providing Trained No. of Amount
Loan Entrepreneurs Entrepreneurs (In Lac BDT) Loan Entrepreneurs Entrepreneurs (In Lac BDT)
1 2 3 4 5 6 7 8 9
 ms‡hvRbx-8

Annual Statement on CMSME Sector’s Credit Activity

Name of the Bank/FI:

Year:
1. Related to Loan Application Settlement

No. of Loan Applications No. of Sanctioned Loan No. of Loan Application No. of Rejected Loan
Received Applications under Processing Applications

1(a). Reason for Rejecting Loan Application

Sl. No. Reasons for Rejection
01.
02.
.......

2. Credit Disbursement through MFI and Agent Banking Linkage

MFI and No. of MFI or No. of Loan Disbursment
Agent Agent Entrepreneurs Amont (In Crore BDT)

3. Women Entrepreneurs’ Dedicated Desk/Help Desk

No. of Total Branches Total No. of Women Entrepreneurs’
Dedicated Desk/Help Desk

4. CMSME Related Certificate Training Program for Bankers and Entrepreneurs

No. of Bankers No. of Traning Program No. of Trained No. of Trained Entrepreneurs
Received Training Related to Entrepreneurs Entrepreneurs Received Loan

Continued/02
 -02-

5. CMSME Loan Categorization Based on Manufacturing and Service Industry

Name of CMSME Industrial Sector No. of Credit Amount of Credit
Recived Enterprises Disbursed (In BDT)
A) Manufacturing
1. Garments and Knitwear Industry
2. Textile Industry
3. Agricultural and Forestry resources processing
industry
4. Jute and Jute Products processing industry
5. Fisheries and Livestock resources processing
industry
6. Plastic and Plastic Goods processing industry
7. Leather, Footwear and Leather Goods processing
industry
8. Electronics, Machinery and Light Engineering
9. Medicine, Chemical, Perfume, Cosmetics and
Toiletries products manufacturing industry
10. Handicraft, Cottage, Loom, Shitol Pati, Nokshi
Katha Industry
11. Toys, Glass, Cookeries and Ceramic Related
Industry
12. Other......
B) Service
1. IT, Software, ICT, Cyber café service etc.
2. Telecommunication, Call Centre, Cable Operator,
Internet Service Provider
3. Saloon, Beauty Parlor, Gym
4. Transportation and Communication Services
(Land, Air and Water)
5. Health Service
6. Social Services
7. Photography, Digital Color Lab,
Phone/Fax/Photocopy/Printing Services
8. Entertainment Services
9. Training Services
10. Other......
 ms‡hvRbx-9
Quarterly Report of Loan on Agro Based Industry
Name of the bank/FI:
Quarter:
(Amount in Crore Taka)
Number of Total Outstanding
Total Loan Disbursement Entrepreneurs Financed (as on end of the Quarter) Classified Amount
Category (Current Quarter) in Current Quarter Total Recovery during current Quarter (as on end of the
Term Working quarter)
Term Loan Working Capital Total Male Female Total
SL Loan Capital
1 Processed fruit based food manufacturing industries (Jam, Jelly, Juice, Pickle, Syrup, Sauce,etc.); 0.00 0.00
2 Fruit (Tomato, Mango, Guava, Sugarcane, Jackfruit, Litchi, Pineapple, Coconut, etc.)Vegetables, and Lentil processing industries; 0.00 0.00
3 Production of Bread & Biscuit, Vermicelli, Chanachur, Noodles, etc.; 0.00 0.00
4 Production of Atta, Flour, and Semolina; 0.00 0.00
5 Processing of Mushroom and Spirulina; 0.00 0.00
6 Starch, Glucose, Dextrose, and other Starch product manufacturing industries; 0.00 0.00
7 Milk processing (Milk pasteurization, powdered Milk, Ice cream, condensed Milk, Sweet,Cheese, Ghee, Butter, Chocolate, Yogurt, etc.) industries; 0.00 0.00
8 Food processed from Potato (Chips, Potato Flakes, Starch etc.) manufacturing industries; 0.00 0.00
9 Various gourd Spices manufacturing industries; 0.00 0.00
10 Edible oil refining and Hydrogenation industries; 0.00 0.00
11 Salt processing industries; 0.00 0.00
12 Prawn and other Fish processing and freezing industries; 0.00 0.00
13 Herbal cosmetic producing industries; 0.00 0.00
14 Unani, Ayurvedic and Homeopathic medicine producing industries; 0.00 0.00
15 Balanced diet manufacturing industries for Duck, Chicken, Cattle and Fish 0.00 0.00
16 Seed producing, research, processing and preservation; 0.00 0.00
17 Jute made product (eg. Rope, Thread, Sackcloth, Bag, Carpet, Jute Sandal etc.) manufacturing industries; 0.00 0.00
18 Silk cloth manufacturing industries; 0.00 0.00
19 Establishing Equipment industry for aiding agricultural production, repairing etc.; 0.00 0.00
20 Rice (including Auto Rice Mill), puffed Rice, beaten Rice (flattened Rice), popped Rice etc.processing (or preparing) industries; 0.00 0.00
21 Perfumed Rice producing/processing (or preparing) industries; 0.00 0.00
22 Tea processing industries; 0.00 0.00
23 Coconut oil producing industries (if Copra collected from local coconut is used); 0.00 0.00
24 Rubber tape, Lakkha processing industries; 0.00 0.00
25 Cold storage (processing and preservation of Potato and Seed-potato, Fruits, Vegetables etc. produced by farmers); 0.00 0.00
26 Furniture made/produced from Wood, Bamboo and Cane (except Cottage industries); 0.00 0.00
27 Flower preservation and exporting enterprises; 0.00 0.00
28 Meat processing enterprises; 0.00 0.00
29 Production of Organic Fartilizar, Mixed Fartilizar, Guti Urea etc.; 0.00 0.00
30 Production of Bio-pesticide and Neem-based pesticide; 0.00 0.00
31 Apiculture/honey producing (or processing) projects; 0.00 0.00
32 Rubber-based goods producing (or manufacturing) projects; 0.00 0.00
33 Particle board manufacturing industries; 0.00 0.00
34 Mustard Oil producing industries (if local Mustard is used); 0.00 0.00
35 Bio-gas and Electricity production projects from Paddy shell, Poultry waste and Cow dung; 0.00 0.00
36 Industries producing Edible Oil from Rice Bran; 0.00 0.00
37 Poultry and Dairy industries; 0.00 0.00
38 Sugar and other Sweetened product producing industries; 0.00 0.00
39 Soya food producing and Soybean processing industries; 0.00 0.00
40 Horticulture, Floriculture, Flower and Vegetable marketing (Lemon, Mushroom, Beetle Leaf, Honey etc. will be included in this industry) 0.00 0.00
41 Others 0.00 0.00
Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Name Name
ID No ID No
Cell Cell
Email Email
 ms‡hvRbx-10

Quarterly Statement of Industrial Loan

Name of the Bank/FI:
Name of the Quarter:

(Amount in Crore BDT)

Loan During the Quarter Balance at the End of the Quarter
Nature of Loan Size of Industry
Sanctioned Disbursed Recovered Overdue Outstanding Classified
1 2 3 4 5 6 7 8

Large Scale

Term Medium-Scale

Small, Micro
and Cottage

Large Scale

Working Capital Medium-Scale

Small, Micro
and Cottage

Authorized Signature Authorized Signature

Name of Contact Person:

Designation:
Cell Phone Number:
 ms‡hvRbx-11

List of Agro-based Industries

1. Processed fruit based food manufacturing industries (Jam, Jelly, Juice, Pickle, Syrup, Sauce,
etc.);
2. Fruit (Tomato, Mango, Guava, Sugarcane, Jackfruit, Litchi, Pineapple, Coconut, etc.),
Vegetables, and Lentil processing industries;
3. Production of Bread & Biscuit, Vermicelli, Chanachur, Noodles, etc.;
4. Production of Atta, Flour, and Semolina;
5. Processing of Mushroom and Spirulina;
6. Starch, Glucose, Dextrose, and other Starch product manufacturing industries;
7. Milk processing (Milk pasteurization, powdered Milk, Ice cream, condensed Milk, Sweet,
Cheese, Ghee, Butter, Chocolate, Yogurt, etc.) industries;
8. Food processed from Potato (Chips, Potato Flakes, Starch etc.) manufacturing industries;
9. Various gourd Spices manufacturing industries;
10. Edible oil refining and Hydrogenation industries;
11. Salt processing industries;
12. Prawn and other Fish processing and freezing industries;
13. Herbal cosmetic producing industries;
14. Unani, Ayurvedic and Homeopathic medicine producing industries;
15. Balanced diet manufacturing industries for Duck, Chicken, Cattle and Fish;
16. Seed producing, research, processing and preservation;
17. Jute made product (eg. Rope, Thread, Sackcloth, Bag, Carpet, Jute Sandal etc.) manufacturing
industries;
18. Silk cloth manufacturing industries;
19. Establishing Equipment industry for aiding agricultural production, repairing etc.;
20. Rice (including Auto Rice Mill), puffed Rice, beaten Rice (flattened Rice), popped Rice etc.
processing (or preparing) industries;
21. Perfumed Rice producing/processing (or preparing) industries;
22. Tea processing industries;
23. Coconut oil producing industries (if Copra collected from local coconut is used);
24. Rubber tape, Lakkha processing industries;
25. Cold storage (processing and preservation of Potato and Seed-potato, Fruits, Vegetables etc.
produced by farmers);
26. Furniture made/produced from Wood, Bamboo and Cane (except Cottage industries);
27. Flower preservation and exporting enterprises;
28. Meat processing enterprises;
29. Production of Organic Fartilizar, Mixed Fartilizar, Guti Urea etc.;
30. Production of Bio-pesticide and Neem-based pesticide;
31. Apiculture/honey producing (or processing) projects;
32. Rubber-based goods producing (or manufacturing) projects;
33. Particle board manufacturing industries;
34. Mustard Oil producing industries (if local Mustard is used);
35. Bio-gas and Electricity production projects from Paddy shell, Poultry waste and Cow dung;
36. Industries producing Edible Oil from Rice Bran;
37. Poultry and Dairy industries;
38. Sugar and other Sweetened product producing industries;
39. Soya food producing and Soybean processing industries;
40. Horticulture, Floriculture, Flower and Vegetable marketing (Lemon, Mushroom, Beetle Leaf,
Honey etc. will be included in this industry).
 ms‡hvRbx-12

SME & Special Programmes Department

Bangladesh Bank
Head office, Dhaka
Application for Sanctioning Refinance
Sl. No. Description Relevant Information Remarks
1 Name of Bank/Financial Institution (FI)
2 Date of Application
3 Financing Period
4 Description of the Refinance Applied for:
Loan Type Number Amount (In BDT)
Working Capital
Mid Term
Long Term
Total
5 Availed Amount of Refinancing and Balance Outsatnding thereof by the Bank/FI under this scheme:
Availed Refinance Outstanding with BB
Catagory of Loan Amount Amount
Number Number
(In BDT) (In BDT)
Working Capital
Mid Term
Long Term
Total
6 Entrepreneurial Level Description of the Financed Projects under this Application
Type of Entrepreneur Number Amount (In BDT)
New
Existing
Total
7 Type of Projects Financed under this Application
Type of Project Number Amount (In BDT)
Manufacturing
Service
Trading
Total
8 Detail of Availed Refinance Facility by the Bank/FI from Other Funds of Bangladesh Bank
Availed Refinance Outstanding with BB
Name of the Scheme Amount Amount
Number Number
(In BDT) (In BDT)

Total
9 Whether Enterprise(s) is(are) Defaulter(s) under Refinancing?
Amount (In BDT)/
Financial Information of the Bank/FI Date
Ratio
10 Capital Requirement
Present Capital
Percentage of Non-performing Loan against Total Disbursement
Capital Adequacy Ratio
 ms‡hvRbx 12(K)

Statement of Loan Applied for Refinance

Name of the Bank/FI:
Name of the Month:
Fixed Assets Nature of Number of Type of
Name of Whether
Name of the Location/ of the Enterprise Employee Amount of Loan
Owner(s), Name of Name/ the Loan Date of Interest Tenure
Sl. Enterprise and Address of Type of Male/ Enterprise (Manufact Purpose Loan Limit Disbursed Grace (Working
NID and Financing Type of is Disburse- Rate of Loan Remarks
No. Date of the Ownership Female (excluding -uring/ Male Female of Loan (In BDT) Loan Period Capital/
Phone Branch Product Existing/ ment (%) (Month)
Incorporation Enterprise Land & Service/ (In BDT) Term
Number New
Building) Trade) Loan)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

 Whether the entrepreneur availed refinanced facility under the same refinance scheme previously. If yes, please mention amount and date of availing such facility.

 Whether any refinance application has been submitted for the same loan to any other refinance schemes of Bangladesh Bank. If yes, please mention the name of that scheme and
application date.