ANNEXURE-II To ‘The Branch Manager LOAN APPLICATION FORM FOR AGRICULTURAL CREDIT FOR PM-KISAN BENEFICIARIES A. For office use: ‘Application SLNo, Category 3 ME Others B._Type of KCC/ Amount of loan required: (Please tick (V7) the appropriate box) Tsu of fesh KCC TI Enhancement of existing imit | C) Activation of inoperative KCC account ‘Amount of Loan required C._ Particulars of the applicant(s): ‘Name of the Applicant “Account No (PM Kisan Benetician*) TF not covered under Pardhan Mantra | Name ot | Annual Premium | Sum Assured | Consent (Please dick (7 yihe Suraksha Bima Yojana (PMSBY) and | scheme appropriate box) Pradhan Mantri Jeevan Jyoti Bima Yojana (PMIBY), consent for Auto | PMSBY Rs Rad kakh Ove ]ONo Debit for coverage under these two schemes, PMIBY | Rs3307 Rs 2 Lakh ve [ONo “Amount to be debited from PM-RISAN account = Rs-12/- per annum for PMSBY and Rs.330/- per annum for PMIJBY. "The RYC and other details of the applicant will be accessed from this account D._Detals of existing loans, ifany: Bank/ Co-operative Banks! [Branch Name Faciiy ‘Outstanding (RS) ‘Overdues, irany (RS) Other Sources (KCC/ATL) E. Particulars of total and holdings ofthe applicant and crops: Name of the | Survey’ Khasra Title “Area Ta acres [Name of erop 1 be Grown, Village No. ‘Owned | Leased | Share RharifCrops | Rabi Crops | Other Crops Cropper KCC to Fisheries and Animal Husbandry Farmers: Name of Village | Total productive Dairy Animals | Toial Shesp & Goat | Total Pigs | Total Poultry] Others Taland Fisheries © Aquaculture Marine Fisheries © MaricuTare G._ Security Proposed to be offered: Particulars of Primary Security offered Particulars of Collateral Security (where applicable) H. Declaration: We hereby declare that all information furnished by mo‘us is true, correct and complete to the best of my/our knowledge and belief. UWe hereby undertake to abide by the terms and conditions that the Bank may stipulate in sanction ofthis loan and inform Bank in the event of acquiring any other assets during the tenure of the advance. U We hereby declare that UWe have not availed KCC from any other bank branch, Signature! Thumb impression of Borrowers Acknowledgement Received the loan application from She/Smt. residence of on. consumes OF the purpose of opening of KCC account Date: ‘Signature of Omficer