Application ID: (For office use)

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS

EMPLOYMENT GENERATION PROGRAMME (PMEGP)
12 Name of the project / business activity proposed :

13 Amount of loan required (in Rs.)

Capital Expenditure Loan
Working
Building Type Workshed Machinery/ Pre
Capital /
Building Equipment/ Operative
Cash Credit Total
etc. Furniture Cost
Limit
Rented 20000 21820 60000 80000 181820
Details of earlier or current Loan/Grant and subsidy availed from
14 Central/State Govt. Scheme/ or any other Similar Scheme.
Activity of the Project with Address Amount Year of Sanction

I certify that all information furnished by me is true; and that I and any of my dependent have not
borrowed any money under subsidy linked scheme from any Central / State Government or bank for
establishing any such project

Place:
Date: Signature of the Applicant

For Official Use only: (Rejected / to be placed before District Task force Committee)
Reason (if Rejected):

Place: Signature, Name & Designation of Officer

Date:
 NOTE

• Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North

East Reason/Hill Boarder Area and 10% for General
• Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for
service unit.
• Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own
Contribution over and above the prescribed limit.
• VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector
above Rs.5 lakhs
• Application should be submitted complete in all respect along with attested copies of the
following documents:
1. Certificate of qualification-academic and technical (if project cost above 5 lakhs under
service industry or above 10 lakhs under Manufacturing industry)
2. Relevant Certificate for SC/ST/OBC/Minority/Ex-Servicemen/PHC
3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks)
then submit photocopy of the certificate
 DATA INPUT SHEET

Preference for sponsoring agency of the project to Bank: (mark √ )

1.1 Name of the Applicant/Institution
Project Applicant Test
1.1 Name of the Father/Spouse
TestSpouse
2 Gender Male √ Female
3 Address of the Proposed location of Unit: Rural Urban √
jhandalkd;lja
sarara
Taluka/Block: test tluka
District: satara Pin:
State: magharashtra
Email: satara@gmail.com Mobile: 92394238998

4 Qualification
Academic Technical
12th Pass computer

5 Whether the applicant belongs to (mark √)

Ex- Service Hill Boarder
SC ST PHC Minority General
man Area
√

Manu-
Whether the
√
Service
6 facturing
project (mark √) Unit
Unit
8 Name of the project / business activity proposed :
Test 1

Legal Status:

Land 10000 ###

BUILDING DETAILS
Particulars Area Rate/Sq.ft Amount in Rs.
test 100 200.00 20000.00
0.00
0.00
0.00
0.00
0.00
0.00

MACHINERY DETAILS
Particulars Qty. Rate Amount in Rs.
te3st machinery 2 100.00 200.00
test 1 10 12.00 120.00
test 2 15 100.00 1500.00 Male
test 5 0.00
0.00
0.00 KVIC
0.00
0.00 DIC (
0.00
0.00
0.00 Rura
0.00

Total 1820.00 No

d. Preliminary & Pre-operative Cost : 10000.00 SC

e. Furniture & Fixtures : 20000.00

f. Contingency/Others/Miscellaneous 50000.00

Working Capital : 80000.00

 Manu

Means of Financing ###

Own Contribution : 5%
Bank Finance : 95%
Margin Money (Govt. Subsidy) : 25%

DETAILS OF SALES Own

Rate/ Qantity Amount in Rs.
Particulars of Products
Unit
wirutuisg 12.00 100 1200.00
test 12.00 500 6000.00
0.00
0.00
0.00
0.00
0.00

Total 7200.00

RAW MATERIALS
Particulars Unit Rate/Unit Reqd. Unit Amount In Rs.
RAW MATERIALS 10 13.00 1111 14443.00
test 10 15.00 1222 18330.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 32773.00

WAGES
No. of Wages Per Month Amount in Rs.
Particulars
Worker Total Month 12
testkkkkoiijl 21 11000.00 2772000.00
wearwert 20 1000.00 240000.00
0.00
0.00
0.00
0.00
0.00
Total 41 3012000.00

SALARY DETAILS
No. of Wages Per Month Amount in Rs.
Particulars
Staff Total Month 12
testyuyuu 5 10.00 600.00
sandy 10 20.00 2400.00
0.00
0.00
0.00
Total 15 3000.00

WORKING CAPITAL ESTIMATE

Element of Working Capital No. of Days
2000 10

Stock in process 20

Finished goods 30

Receivable by 10

POWER ESTIMATE
Power Requirement 200

Repair and Maintanance 12.00% Rs. 864.00

Power and Fuel 13.00% Rs. 936.00

Other Overhead Expenses 14.00% Rs. 1008.00

Telephone Expenses 15.00% Rs. 1080.00

Stationery & Postage 12.00% Rs. 864.00

Advertisement & Publicity 11.00% Rs. 792.00

Building Rent Rs. 100.00

Other Miscelleneous Expenditure 9.00% Rs. 648.00

Rate of Interest 1.00%

Depreciation
On Building 12.00%
On Machinery 1.00%

INTRODUCTION
Inteodduction vof the project report

ABOUT THE PROMOTER

proimoter of the project report
 PROJECT AT A GLANCE - TOP SHEET
1 Name of the Entreprenuer Project Applicant Test

2 Constitution (legal Status) Individual

3 Father's/Spouce's Name TestSpouse

4 Unit Address : jhandalkd;lja

sarara
Taluk/Block: test tluka
District : test tluka
Pin: 0 State: Maharashtra
E-Mail : satara@gmail.com
Mobile 92394238998
5 Product and By Product

6 Cost of Project : Rs. 7,13,440

Name of the project / business Test 1
activity proposed :
7 Means of Finance
Term Loan Rs. 6,77,768.00
KVIC Margin Money Rs. 1,78,360.00
Own Capital Rs. 35672.00

8 Debt Service :
Coverage Ratio

9 Pay Back Period : 5 Years

10 Project : 0 Months
Implementation
Period

11 Break Even Point :

12 Employment : 56

13 Power Requirement : 200

14 Major Raw materials : RAW MATERIALS,test,

15 Estimated Annual : Rs. 7200.00

Sales Turnover

PMEGP Project Report Page 10

 DETAILED PROJECT REPORT
1 INTRODUCTION :

Inteodduction vof the project report

2 ABOUT THE PROMOTER :

proimoter of the project report

3 COST OF PROJECT
A. Fixed Capital Investment
a. Land : 10000 Own

b. Workshed Area Sq.ft Rate in Rs. Amt. In Rs.

test 100 200.00 20000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 20000.00
#REF!
C. Machinery Qty. Rate Amount in Rs.
te3st machinery 2 100.00 200.00
test 1 10 12.00 120.00
test 2 15 100.00 1500.00
test 5 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 1820.00

PMEGP Project Report Page 11

 d. Preliminary & Pre-operative Cost : Rs. 10000.00

e. Furniture & Fixtures : Rs. 20000.00

f. Contingency/Others/Miscellaneous Rs. 50000.00

Total Capital Expenditure : Rs. 101820.00

Working Capital : Rs. 611620.00

Total Cost Project : Rs. 713440.00

3.1 Means of Financing :

Own Contribution 5% Rs. 35672.00

Bank Finance : 95%

Term Loan Rs. 96729.00
Working Capital Rs. 581039.00

Total Rs. 677768.00

Margin Money (Govt. Subsidy) 25% Rs. 178360.00

Margin Money Subsidy received will be kept in term deposit as per norms of
CMEGP in the name of Beneficiary for three years in the financing branch.

3.2 STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :
TERM LOAN

Interest @
Year Opening Balance Installment Closing Balance
1.00%
1st 96729 0 96729 967
2nd 96729 19346 77383 967
3rd 77383 19346 58037 774
4th 58037 19346 38692 580
5th 38692 19346 19346 387
6th 19346 19346 0 193
7th 0 0 0 0
8th 0 0 0 0

WORKING CAPITAL

Interest @
Year Opening Balance Installment Closing Balance
1.00%
1st 581039 0 581039 5810
2nd 581039 116208 464831 5810
3rd 464831 116208 348623 4648
4th 348623 116208 232416 3486
5th 232416 116208 116208 2324
6th 116208 116208 0 1162
7th 0 0 0 0
8th 0 0 0 0

PMEGP Project Report Page 12

3.3 STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:
WORKSHED @ 12.00%
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Opening Balance 20000 17600 15488 13629 11994
Depreciation 2400 2112 1859 1636 1439
Closing Balance 17600 15488 13629 11994 10555
MACHINERY @ 1.00%
Opening Balance 1820 1802 1784 1766 1748
Depreciation 18 18 18 18 17
Closing Balance 1802 1784 1766 1748 1731
TOTAL DEPRECIATION
Workshed 2400 2112 1859 1636 1439
Machinery 18 18 18 18 17
Total 2418 2130 1876 1653 1457

4 Schedule of Sales Realization :

4.1 Details of Sales
Rate/ No. of Amount in Rs.
Particulars of Product Pair/Unit Pair/Unit
0
wirutuisg 12.00 100 1200.00
test 12.00 500 6000.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
Total 7200.00

4.2 Capacity Utilization of Sales

Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year

Capacity Utilization 70% 80% 90% 90% 90%

Sales / Receipts 5040 5760 6480 6480 6480

5 Rawmaterials :
Particulars Unit Rate/unit Reqd.Unit Amount in Rs.
RAW MATERIALS 10 13.00 1111 14443.00
test 10 15.00 1222 18330.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
Total 32773.00
5.1 Wages :
No. of Wages Amount in Rs.
Particulars Worker Per Month (Per Annum)
testkkkkoiijl 21 11000.00 2772000.00
wearwert 20 1000.00 240000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 41 3012000.00

PMEGP Project Report Page 13

5.2 Repairs and Maintenance : Rs. 864.00

PMEGP Project Report Page 14

5.3 Power and Fuel : Rs. 936.00

5.4 Other Overhead Expenses : Rs. 1008.00

6 Administrative Expenses :
6.1 Salary
testyuyuu 5 10.00 600.00
sandy 10 20.00 2400.00
0 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
Total 15 3000.00

6.2 Telephone Expenses 1080.00

6.4 Stationery & Postage 864.00

6.5 Advertisement & Publicity 792.00

6.6 Workshed Rent 1200.00

6.7 Other Miscellaneous Expenses 648.00

Total 7584.00
7 Capacity Utilization of Manufacturing & Administrative Expenses :
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Capacity Utilization 70% 80% 90% 90% 90%
Manufacturing Expenses
Rawmaterials 22941 26218 29496 29496 29496
Wages 2108400 2409600 2710800 2710800 2710800
Repairs & Maintenance 605 691 778 778 778
Power & Fuel 655 749 842 842 842
Other Overhead Expenses 706 806 907 907 907
Administrative Expenses
Salary 3000 3000 3000 3000 3000
Postage Telephone Expenses 756 864 972 972 972
Stationery & Postage 605 691 778 778 778
Advertisement & Publicity 554 634 713 713 713
Workshed Rent 1200 1200 1200 1200 1200
Other Miscellaneous Expenses 454 518 583 583 583
Total: 2139876 2444972 2750069 2750069 2750069
8 Assessment of Working Capital :
Particulars Amount in Rs.
Sale 7200.00

Manufacturing Expenses
Raw Material 32773.00
Wages 3012000.00
Repair & Maintenance 864.00
Power & Fuel 936.00
Other Overhead Expenses 1008.00

Production Cost 3047581.00

Administrative Cost 7584.00
Manufacturing Cost 3055165.00

PMEGP Project Report Page 15

 Working Capital Estimate :
Element of Working Capital No of Days Basis Amount in Rs.
2000 10 Material Cost 1092.00

Stock in process 20 Production Cost 203172.00

Finished goods 30 Manufacturing Cost 305517.00

Receivable by 10 Manufacturing Cost 101839.00

Total Working Capital Requirement Per Cycle 611620.00

9 Financial Analysis
9.1 Projected Profit & Loss Account :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Sales / Receipts 5040 5760 6480 6480
5040 5760 6480 6480
Manufacturing Expenses
Rawmaterials 22941 26218 29496 29496
Wages 2108400 2409600 2710800 2710800
Repairs & Maintenance 605 691 778 778
Power & Fuel 655 749 842 842
Other Overhead Expenses 706 806 907 907
Depreciation 2418 2130 1876 1653
Production Cost 2135725 2440195 2744699 2744476
Administrative Expenses
Salary 3000 3150 3308 3473
Postage Telephone Expenses 756 864 972 972
Stationery & Postage 605 691 778 778
Advertisement & Publicity 554 634 713 713
Workshed Rent 1200 1200 1200 1200
Other Miscellaneous Expenses 454 518 583 583
Administrative Cost 6569 7057 7554 7719
Interest on Bank credit @ 1%
Term Loan 967 967 774 580
Working Capital Loan 5810 5810 4648 3486
Cost of Sale 2149071 2454030 2757675 2756261
Net Profit Before Tax -2144031 -2448270 -2751195 -2749781
Less Tax 0.00 0.00 0.00 0.00
Net Profit -2144031 -2448270 -2751195 -2749781

9.2 CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit -2144031 -2448270 -2751195 -2749781
Add :
Depreciation 2418 2130 1876 1653
TOTAL - A -2141613 -2446140 -2749319 -2748128
Payments :
On Term Loan :
Interest 967 967 774 580
Installment 0 19346 19346 19346
On Working Capital
Interest 5810 5810 4648 3486
TOTAL - B 6778 26123 24768 23412
D.S.C.R = A/B
-315.98 -93.64 -111.00 -117.38
Average D.S.C.R

PMEGP Project Report Page 16

9.3 PROJECTED BALANCE SHEET :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
LIABILITIES :
Promoters Capital 35672 35672 35672 35672
Profit -2144031 -2448270 -2751195 -2749781
Term Loan 96729 96729 77383 58037
Working Capital Loan 581039 581039 464831 348623
Current Liabilities 0 0 0 0
Sundry Creditors 0 0 0 0
-1430591 -1734830 -2173309 -2307449
ASSETS :
Gross Fixed Assets : 41820 39402 37272 35395
Less : Depreciation 2418 2130 1876 1653
Net Fixed Assets 39402 37272 35395 33742
Preliminary & Pre-Op. Expenses 10000 7500 5625 4219
Current Assets 581039 581039 464831 348623
Cash in Bank/Hand -2051032 -2353140 -2673535 -2689814
Total -1430591 -1734830 -2173309 -2307449

9.4 CASH FLOW STATEMENT :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit -2144031 -2448270 -2751195 -2749781
Add : Depreciation 2418 2130 1876 1653
Term Loan 96729 96729 77383 58037
Working Capital Loan 581039 581039 464831 348623
Promoters Capital 35672 0 0 0
Total -1428173 -1768372 -2207104 -2341467

Total Fixed Capital Invested 101820

Repayment of Term Loan 0 19346 19346 19346

Repayment of WC Loan 0 116208 116208 116208
Current Assets 581039 581039 464831 348623
Total 581039 716593 600385 484177

Opening Balance 0 -2009212 -4494176 -7301666

Surplus -2009212 -2484964 -2807489 -2825644
Closing Balance -2009212 -4494176 -7301666 -10127310

9.5 BREAK EVEN POINT AND RATIO ANALYSIS :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Fixed Cost 9954 10155 10204 9952
Variable Cost 2141535 2446005 2749348 2747962
Total Cost 2151490 2456160 2759551 2757914

Sales 5040 5760 6480 6480

Contribution (Sales-VC) -2136495 -2440245 -2742868 -2741482

B.E.P in % -0.47% -0.42% -0.37% -0.36%

Break Even Sales in Rs. -23 -24 -24 -24

Break Even Units -2 -2 -2 -2

Current Ratio 85.73 4.08 3.30 2.50

PMEGP Project Report Page 17

 Net Profit Ratio -42540.31% -42504.68% -42456.71% -42434.90%

PMEGP Project Report Page 18

 This Project Report has been prepared based on the data furnished by the entrepreneur whose details are
given in the application.
Place :
Date:
Prepared by :
Full Name : PROJECT APPLICANT TEST

Signature of the Beneficiary

PMEGP Project Report Page 19

 PROJECT REPORT FOR

Affix latest
attested
Photograph

1 Name of the Entreprenuer Project Applicant Test

1
2 Constitution (legal Status) Individual

3 Father's/Spouce's Name #REF!

5 Unit Address : jhandalkd;lja

sarara
Taluk/Block: test tluka

District : test tluka

Pin: 0 State: #REF!
Phone #REF!
E-Mail #REF!

6 Background of the Proprietor/Partners/Directors : Furnished detailed information in the DPR

7 Name of Business House/Group if any :

8 Details Other Companies/Units in the group :

Other Companies / Units in the Group (Rs. in Lakhs)
Name & Address Business Equity Reserves Loans Turnover *P.B.T **P.A.T
of Company / Unit

* Profit Before Tax ** Profit After Tax

`

8.1 How the activity was financed so far : ( To be filled up in case of existining unit Only )
*Source of Funds Security Rate of Repayment per Present O/s Amount of Default
Interest Month ( Rs. in '000 ) (if any)

8.2 If the Unit is an ancillary one, undertaking to

which it is catering and its address :
8.3 Employment : Present Proposed
testkkkkoiijl 21
wearwert 20
0 0
0 0
0 0
0 0
0 0
testyuyuu 5
sandy 10
0 0
0 0
0 0
Total 56

9 Project Details for Proposed New Unit : Copy of detailed project report is enclosed.
a Expansion / Mordenisation :

b Setting up of New unit :

c Activity for proposed new unit :

d Product / Item proposed to undertake :

9.1 Capacity (Furnish the details of Installed capacity & production : (No. in Units/ Qty. in Kg./Volume in liter per annum)
Capacity is arrived at on the basis of Days working on shift basis
Product & Present Installed Maximum Prod. Proposed Installed Maximum Prod.
By-product if any Capacity Achieved Capacity of 1st Year envisaged
70.00% 2135725

9.3 State the manufacturing process in brief :

9.4 Has the proposed process ever been tried in the
country or newly adopted? :

9.5 Technical Arrangements :

9.6 Describe arrangement for Key Official

for managing the proposed unit :
Technical Manpower

Administrative Manpower

Accounting personnel

9.7 Particulars of Land Existing Proposed

Location of the Land :
Area of Land
Status of the Land
Nature of Land
Availability of Water :

9.8 Particulars of Building Existing Proposed

(Enclose the plan & Estimation for the proposed Building) Area Value in Rs. Status Area Value Status
Factory Building :

Ancillary Building

Storage

Total 0.00 0.00

9.9 Plant and Machinery Existing (Value in Rs.) Proposed (Value in Rs.)
Indigenous 1820.00

Imported

(Enclose the plan layout of the existing plant and machinery )

9.10 Rawmaterials / Components
Req. of Raw material/Components/Chemicals Qty. in Nos./Kgs./Ton Rate/Nos./Kgs/Tons Value in Rs.

Total 0.00

9.11 Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)
Particulars of Utilities Contracted Load Connected Load Further requirement
in HP/KW/W in HP/KW/W in HP/KW/W
Power

Water

Fuel

Others (Specify)
9.12 Environment Aspect of the Project :

9.13 Requirement of Manpower for the Project :

Particulars of Manpower Total Requirement Salary/Wages per month Cost per Annum
testkkkkoiijl 21 11000.00 2772000.00
wearwert 20 1000.00 240000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
testyuyuu 5 10.00 600.00
sandy 10 20.00 2400.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 56 3015000.00

9.14 Schedule of Implementation : BAR CHART

Activities Date of Commencement Expected Date of Completion
a. Acquisition of Land
b. Development of Land
c. Civil Works for Factory / Building
Machinery / Foundation etc..
d. Plant & Machinery
Imported
Indigenous
e. Arrangement for power
f. Arrangement for water
g. Errection of equipment
h. Commissioning
I. Procurement of Raw materials/Chemicals
j. Trail Runs
k. Commercial Production
10 Cost of Project :
(Rs. in '000)
Sr.No. Particulars Already Incurred To be Incurred Total Cost
A Land including Development 0.00 0.00

B Building & Other Civil Works 20000.00 20000.00

C Plant and Machinery

1. Indigenous 1820.00 1820.00
2. Imported 0.00

D Furniture & Fixture 20000.00 20000.00

E Testing equipment 0.00

F Miscellaneous Fixed Assets 0.00

G Errection & Installation Charges 0.00

H Contingency 50000.00 50000.00

I Preliminary & Pre-Op. Cost 10000.00 10000.00

J Provision for
1. Buildings 0.00
2. Plant & Machinery 0.00
3. Other Fixed Assets 0.00

K Working Capital for one 611620.00 611620.00

Operating Cycle

L Total 0.00 713440.00 713440.00

 11 Means of Financing :
(Rs. in '000)
Sr.No. Particulars Amount already Amount Proposed Total
Raised to be Raised
A Equity / Promoters Contribution 35672.00 35672.00

B Reserves 0.00

C Term Loans 677768.00 677768.00

D Unsecured Loans and Deposits 0.00

(Indicate sources, roi, repayment etc)

E Deferred Payment 0.00

Arrangements including Suppliers credit

F Subsidy
Central Government 178360.00 178360.00
State Government 0.00

G Seed Capital 0.00

H Internal Cash Accruals 0.00

I Other Sources (Specify) 0.00

J Total 0.00 713440.00 713440.00

11.1 In case internal accruals are taken as

source of finance explain the basis of
estimation of internal accruals :

11.2 Indicate source from which expenditure

already incurred has been financed :

11.3 % of Promoters contribution of the :

total cost of project
 12 Marketing & Selling Arrangements of the Product :

13 Projected Profitability : Projected Profitability Statement given in the

Detailed Project Report.

14 Projected Cash flow Statement : Projected Cash flow Statement given in the
Detailed Project Report.

% of Cash Sales in Total Sales :

Period in which payment is received Days

in respect of Credit Sales

Average Credit Available on Purchase : Days

15 Working Capital Required for the : Rs. 611620.00

anticipated turnover

16 Repayment Programme : Detailed Repayment programme for Term loan and

Working capital loan have been given in the DPR.

17 Details of Securities to be Offered :

17.1 Primary ( Furnish details for term loan and : :

working capital loan separately )
17.2 Collateral, if any (Details) :

17.3 Details of Guarantor(s) :

1. Name
2. Residential Address :

3. Occupation :
4. Details of movable & immovable
properties owned by him /her/other
family members

5 Details of any other similar guarantees:

if any, given to other institutions

18 Government Consents :
(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)

19 DECLARATION

I / We hereby declare that the information given herein before and the statements and other
papers enclosed are, to the best of our knowledge and belief, true and correct in all particulars

Date : 0 Signature of the Borrower

Place : 0 Name & Designation (In case of Regd. Inst.)
 Project Report on

Prepared By:
#REF!
District Industries Center
#REF!
#REF!
#REF! State: #REF!
e-Mail:
Ph. No.: Fax: