Vidya Lakshmi Common Education Loan Application Form

Student ID 2004774

Application ID 1093394

Bank Name Union Bank of India

Bank Scheme Name UNION EDUCATION - STUDY IN INDIA AND ABROAD

Preferred Bank IFSC Code UBIN0812692

Preferred Bank Branch Name KARAIKAL

Date of Application 09-Jul-2021

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Kumari Mr.

First Name LATCHUMI STALIN

Middle Name

Last Name S G

Father’s /Husband’s First Name STALIN GURUSAMY

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name G K

Date of Birth 11/05/2002 20/01/1976

Category SC SC

Sex Female Male

Marital Status Single Married

Educational Qualification B.Sc NURSING

Marks obtained in Highest

77.0 0.0 0.0
qualification %

Occupation Student Employee

Income from all sources (Rs) 72000.00

PAN No.# BIKPL7012E HXZPS5023Q

State Puducherry Puducherry

Address Line 1 68, GNANAPRAGASAM STREET 68, GNANAPRAGASAM STREET

Address Line 2

Village / Area/ Locality KARAIKAL KARAIKAL

Block/Taluka /Sub-district/Town Karaikal Karaikal

PIN 609602 609602

Contact No. 9788561305 9788561305

e-mail Id latchumik305@gmail.com latchumik305@gmail.com

Present Banker Details

Branch IFSC UBIN0812692 UBIN0812692

Banker Union Bank of India Union Bank of India

Bank Branch KARAIKAL KARAIKAL

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Account Type Savings Account Savings Account

SB / OD A/c No. 126912010000002 126912010000002

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

COLLEGE OF NURSING, EAST COAST INSTITUTE OF MEDICAL

Name of the Institution
SCIENCES

Name of the Course BACHELOR OF SCIENCE IN NURSING(NURSING)(3 YEARS)

Duration of the Course 03 (Years) 00 (Months)

Date of Commencement 18/12/2020 Date of Completion 10/12/2023

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 42000 42000 42000 126000.00

Exam fees 3000 3000 3000 9000.00

Books Stationery 9500 9500 9500 28500.00

Equipment/Computer 5000 5000 5000 15000.00

Hostel Expenses 48000 48000 48000 144000.00

Sundries/Travel 9500 9500 9500 28500.00

TOTAL 117000 117000 117000 351000.00

Own Source / Scholarship 0 0 0

Loan Required 117000 117000 117000 351000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
75 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

Parent 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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