7/16/2019 Assets Liabilities Statments - F - 349 for Guarantor

a/c F - 349 for Guarantor 

INDIAN OVERSEAS BANK 

Branch:____________________ 

ASSETS & LIABILITY STATEMENT

From To
The Branch Manager 
Indian Overseas Bank 
Branch:
Date :

Dear Sir,
Ref. : Application for credit facility submitted
 by M/S
for Rs.
.......................................................................................

With reference to the above loan application, I furnish hereunder my personal

information and details of my Assets and Liabilities in Table A and Table D. I also
enclose copies of my Tax Returns / Assessment Order / Salary Certificate / Encumbrance
Certificate of my property for your record.

I hereby declare that the particulars furnished by me hereunder are true to the best of my
knowledge.

Yours faithfully,

Signature

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TABLE : A-- PERSONAL INFORMATION

A.1 NAME
A.1a Dt. of Birth & Age
A.2 Father’s Name / Husband’s Name
(in case of Married women)
A.3 Residential Address & Tel. No.
A.4 Office Address & Tel. No.
A.5 PAN & IT Circle
A.6 Name of Employer / Nature of 
Business / Profession

A.7 Position held now

A.8 Particulars of Previous employment, if 
any
A.9 Monthly Emoluments (if in service)
Cross Income LESS Deductions  Net Emoluments
Per Month Rs. Per Month Rs.  per Month Rs.
1. 2. 3.

A.10 Earning From Profession/Business

Gross Income Less Expenses  Net Earning
Per Annum Rs. Lac
Per Annum Rs. lac Per Annum Rs. Lac
1 2 3

A.11 Name, Address & Tel. No. of my :

 present Banker 
A.12 Details of Guarantee already executed by me
 Name of Principal  Name of  Guarantee Guarantee Valid Remarks
Debtor  Beneficiary Amount upto

1 2 3 4 5

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A.13 Details of Credit Cards held

 Name of Bank Card Limit Nature of Card Dues as on date
1 2 3 4

TABLE : B ASSETS

B. 1 Immovable properties

S.No. Name of the Owner Depreciation Location/Address of  Extent of 

of Property  property (please furnish land
full details with survey No.
Door No. etc.)
1 2 3 4 5
1.
2.
3.
4.

Extent of Building Type of property i.e. whether  Details of  Date of purchase
area residential / agricultural / documents of property
constructed Industrial / commercial, etc., conferring right
6 7 8 9

Original Purchase cost Present market value Details of encumbrances, if 

Rs. Lac Rs. Lac any, on the property
10 11 12

Total
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B.2 Machineries

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Installed at Short Book Value Depreciated Appr. Encumbrance

descrip Rs. value Market of any
tion Lac Rs. Lac Value Rs. Lac

1 2 3 4 5 6

B. 3 Deposits held with companies / others

S.  Name of the company Nature of Deposit Amount

 No. Rs. lac
1 2 3 4

B. 4 Life Insurance Policies

Date of  Policy No. Whether Endowment Annual Sum Surrender 

 policy  policy or while life  premium Assured Value
 policy or other  Rs. Rs. Lac (Rs. Lac)
1 2 3 4 5 6

TOTAL

B. 5 Govt. Securities / NSCs / Shares of Listed Companies

S. Description of Security Face Value Market Value

 No. (Rs. lac) (Rs. Lac.)
1 2 3 4
1
2
3
4

5
6
7
8
9
TOTAL
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B.6 Investments in Business

Sl. No. Name of the company / firm / concern in Amount invested
which investment is made (Rs. Lac)
1 2 3
1
2
TOTAL

B.7 Deposits held with Banks

Sl. No. Name of the Bank Nature of Deposits held Amount Deposited
(Rs. lac)
1 2 3 4
1
TOTAL 0.20

B.8 Vehicle Owned

Description of  Regn. No. Original Depreciated Appr. Market
Vehicle Cost (Rs. lac) Value (Rs. lac) Value Rs. lac
1 2 3 4 5

Insurance company RC book in the name of Encumbrance if any

6 7 8

B. 9 Other Assets Owned

 
Sl.  Nature Description of  Original Cost Depreciated Approximate Encumbrance
 No. assets Rs. lac value Market Value if any
Rs. lac Rs. Lac
1 2 3 4 5 6
1
2
TOTAL

B.10 TOTAL ASSETS (B.1 TO B.9) : Rs. lac

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TABLE : C LIABILITIES

C.1 Borrowings from Banks and Financial Institution

 Nature of the Details of Nature & extent of credit limit / Details of 

Institution / Bank  facilities enjoyed securities furnished

 Nature of Credit facilities Extent (Rs. lac)
1 2.1 2.2 3

C.2 Borrowings from others

 Name of the Lender Amount borrowed (Rs. lac) Details of securities

furnished
1 2 3

C.3 Other Liabilities

 Nature of liabilities Extent of liabilities
(Rs. Lac)
1 2

C.4 TOTAL LIABILITIES (C.1 TO C.3) : Rs. Lacs

TABLE: D NETWORTH

TOTAL ASSETS TOTAL LIABILITIES NET WORTH

D.1 Rs lacs D.2 Rs. Lac (D.1 minus D.2) Rs. lac

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TABLE E : DECLARATION AND UNDERTAKING

E.1 I hereby declare that the assets referred above (Table : B) are owned by me and
these assets are not alienated or encumbered except to the extent furnished in the
statement.

E.2 Further I hereby undertake, not to encumber / alienate the said assets without
 prior intimate to Bank in writing till all my obligations to Bank are fully
discharged.

E.3 I/We also declare that I am not facing any litigations initiated by other banks/
financial institutions and there are no recovery proceedings for arrears of Income
Tax, Sales Tax, Customs duty, Excise duty etc. I declare that neither any
insolvency / winding up proceedings nor any court case is pending against me in
my capacity either as borrower or as guarantor.

(In case any

 pending, the litigation with other
details thereof shouldbank is faced or winding up proceedings / court case is
be furnished)
 Nature of Litigation Brief Particulars
1 2

 Nil

E.4 I am agreeable to the condition that your Bank will have unqualified right to
disclose / publish my name is such manner and through such medium as the bank 
in their absolute discretion may think fit in the event of default by myself.

Date :
Place: Signature of Applicant

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TABLE : F FOR BRANCH USE

1.1 We certify that we have verified the information furnished above, with the

relative records
to the best of ourwherever it isand
knowledge applicable
belief. and the assessment made is true and fair 

1.2 Copies of supporting documents as listed here below have been obtained and held
as branch record.

S.No. List of documents / Papers received

1.
2.
3.

4.
5.

Any other remarks:

Signature of the Branch Manager.

Branch ………………………..

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