Vidya Lakshmi Common Education Loan Application Form

Student ID 1976683

Application ID 1416355

Bank Name State Bank of India

Bank Scheme Name SBI Scholar Loan Scheme

Preferred Bank IFSC Code SBIN0012057

Preferred Bank Branch Name MANGALPUR

Date of Application 25-Jan-2022

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mr. Mr.

First Name Dibyajyoti Dhirendra Dhirendra

Middle Name Kumar Kumar

Last Name Biswal Biswal Biswal

Father’s /Husband’s First Name Dhirendra Banshidhar Banshidhar

Father’s /Husband’s Middle Name Kumar

Father’s /Husband’s Last Name Biswal Biswal Biswal

Date of Birth 13/07/1996 05/06/1969 05/06/1969

Category Others Others Others

Sex Male Male Male

Marital Status Single Married Married

Educational Qualification Bachelor of Technology Bachelor of Arts Bachelor of Arts

Marks obtained in Highest

81.5 0.0 0.0
qualification %

Occupation Student Employee Employee

Income from all sources (Rs) 788111.00 788111.00

PAN No.# CVKPB5344R AIQPB1703R AIQPB1703R

State Odisha Odisha Odisha

Address Line 1 Vill: Nachhindrapur Vill: Nachhindrapur Vill: Nachhindrapur

Address Line 2 Po: Khannagar Po: Khannagar Po: Khannagar

Village / Area/ Locality Via: Mangalpur Via: Mangalpur Via: Mangalpur

Block/Taluka /Sub-district/Town Jajpur Jajpur Jajpur

PIN 755011 755011 755011

Contact No. 7439223838 9458492453 9458492453

e-mail Id dibyajyotibiswal1996@gmail.com biswaldhirendra69@gmail.com biswaldhirendra69@gmail.com

Present Banker Details

Branch IFSC SBIN0012057 SBIN0012057 SBIN0012057

Banker STATE BANK OF INDIA STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch MANGALPUR MANGALPUR MANGALPUR

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Account Type Savings Account Savings Account Savings Account

SB / OD A/c No. 20313579185 30254497906 30254497906

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

NARSEE MONJEE INSTITUTE OF MANAGEMENT STUDIES,

Name of the Institution
MUMBAI

Name of the Course MASTER OF BUSINESS ADMINISTRATION(M.B.A)

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 08/06/2021 Date of Completion

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 600000 600000 1200000.00

Exam fees 200000 200000 400000.00

Books Stationery 6000 5000 11000.00

Equipment/Computer 289000 289000 578000.00

Hostel Expenses 0 0

Sundries/Travel 0 0

TOTAL 1095000 1094000 2189000.00

Own Source / Scholarship 1095000 0 1095000.00

Loan Required 0 1094000 1094000.00

5.Details of securities offered NA

6.Prospects of earning after completion of the course

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

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Applicant Photo

Parent Photo

Co-obligant / Guarantor 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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